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. 2014 Spring;5(2):89-93.

Ileocecal patch -low rectal anastomosis in total colectomy: New idea for the prevention of fecal incontinence

Valiullah Mehrabi  1 , Leily Mohajerzadeh  2 , Alireza Mirshemirani  2 , Ahmad Khaleghnejad Tabari  2 , Azadeh Falahi  1 , Shabnam Abtahi  1 , Marjan Kafaei  2
Affiliations

Ileocecal patch -low rectal anastomosis in total colectomy: New idea for the prevention of fecal incontinence

Valiullah Mehrabi et al. Caspian J Intern Med. 2014 Spring.

Abstract

Background: Total colectomy is used in children with total colonic aganglionosis, Ulcerative colitis (UC) and familial adenomatous polyposis (FAP). The purpose of this study was to maintain ileocecal valve and rectal-sparing surgery for the prevention of fecal incontinence in these children.

Methods: From1990 to 2011, 14 children with diagnosis of UC, FAP and Hirschsprung's disease were operated. Total colectomy was done with the preservation of patch of cecum with ileocecal valve and half of the rectum with ileocecorectal anastomosis. Distal ileum designed as S shape pouch and ileocecal valve were preserved. In Hirschsprung's disease, posterior rectal myotomy was established. The data were collected and analyzed.

Results: The mean age of the patients was 54 months (ranged from 2 months to 18 years). Ten patients were male. Among 14 patients, Hirschsprung's disease, ulcerative colitis and FAP were seen in 10, 3, and one case, respectively. They were followed up annually. Clinical and endoscopic examinations were performed to evaluate the function of ileocecorectal anastomosis. They followed from 2 to 24 years. At first year, the patients experienced four to six bowel movements during the day and one at night. This frequency decreased over time. The main postoperative complications included recurrent enterocolitis (n=2), perianal fistula (n=2). Only 2 patients were suffering from some degree of fecal soiling.

Conclusion: The results show that the Ileocecal patch- low rectal anastomosis in total colectomy leads to low complications and prevent fecal frequency and incontinence. It also increases absorptive function of ileum in children.

Keywords: Hirschsprung.; Ileocecal patch; Total colostomy; Ulcerative colitis.

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Figures

Figure 1
Figure 1
Resection of 20 centimeters of terminal ilium including iliocecal valve and part of cecum
Figure 2
Figure 2
Anastomosis of terminal ilium patch as shown above to the rectum
Figure3
Figure3
Barium enema study in a patient with ulcerative colitis 10 years after primary surgery
See this image and copyright information in PMC

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