Ileocecal reservoir reconstruction after total mesorectal excision: functional results of the long-term follow-up.
BACKGROUND
The aim of this study is to obtain functional results of the long-term follow-up after TME and ileocecal interposition as rectal replacement.


METHODS
The study included patients operated on between March 1993 and August 1997 who received an ileocecal interposition as rectal replacement. Follow-up was carried out 3 and 5 years postoperatively. For statistical analysis, the paired t-test, rank test (Wilcoxon), and chi-square or Fisher's exact test were applied; level of significance, P<0.05.


RESULTS
Forty-four patients were included in the studies. Of these, five were not available and four patients could not be evaluated (dementia 1, radiation proctitis 1, fistula 1, pouchitis 1). Seventeen patients died during the observation period; 12 died of the disease. Recurrence of the disorder occurred in 2 of 35 patients (5.7%); 26 and 18 patients, 3 and 5 years postoperatively, respectively remained in the study. At 5 years, 78% of the patients were continent; mean stool frequency was 2.5+/-1.6 per day.


CONCLUSIONS
Functional results and subjective assessment of ileocecal interposition were constant at 3 and 5 years postoperatively. If construction of a colonic J-pouch is not possible due to lack of colonic length, especially after prior colonic resections, the ileocecal interpositional reservoir may offer an alternative to rectal replacement.
Hamel
C T
CT
Department of Surgery, Kantonsspital, Basel University, Spitalstrasse 21, 4031 Basel, Switzerland. cthamel@bluewin.ch.
Metzger
J
J
Curti
G
G
Degen
L
L
Harder
F
F
von Flüe
M O
MO
D000714:Anastomosis, Surgical; D002432:Cecum / Q000601:surgery*; D039021:Colonic Pouches; D005500:Follow-Up Studies; D006801:Humans; D007082:Ileum / Q000601:surgery*; D019651:Plastic Surgery Procedures / Q000379:methods*; D012004:Rectal Neoplasms / Q000473:pathology / Q000601:surgery*; D016019:Survival Analysis