Creation of a pedicle valve unit (PVU) for establishment of enteric continence. Experimental observations.
The aim of this study was to develop a natural tissue valve that could be anastomosed into any area of the gastrointestinal (GI) tract to act as a fecal "brake" and so establish enteric continence at that site. A 4-cm-long valve created from an intussuscepted small bowel pedicle was anastomosed into the cecum and brought out through the abdominal wall as a stoma in 11 rabbits. The animals were re-explored five weeks later for assessment of valve viability and continence and microscopic appearance. In all cases, the valve was fully continent in vivo. All valves were viable, and there was no anastomotic leakage. Pressure testing of the valve at reoperation revealed that 7 of 10 valves tested withstood pressures of 30 mmHg before and after catheterization and 6 of 10 were fully continent to cecal "blanching" pressure (50 mmHg). Valve failure was due to deintussusception in three cases. In four cases, valves were continent over 50 mmHg and showed no tendency to incontinence to bursting pressure of the cecum. We conclude that a continent pedicle valve unit (PVU) for placement in a variety of locations in the GI tract is feasible. The PVU has implications in the management of short-gut syndrome, incontinent ileostomy, continent cecostomy, and as a continent valve placed in the perineum for restoration of perineal defecation following proctectomy.
Pezim
M E
ME
Department of Surgery, University of British Columbia, Vancouver, Canada.
Johnson
H W
HW
Gillespie
K D
KD
Willard
P
P
Owen
D A
DA
D000714:Anastomosis, Surgical / Q000379:methods; D000818:Animals; D001284:Atrophy; D002432:Cecum / Q000473:pathology / Q000502:physiology / Q000601:surgery*; D005242:Fecal Incontinence / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D007082:Ileum / Q000473:pathology / Q000502:physiology / Q000637:transplantation*; D007249:Inflammation; D007413:Intestinal Mucosa / Q000473:pathology; D011312:Pressure; D011817:Rabbits; D012086:Reoperation; D014182:Transplantation, Autologous