Physiological and pharmacological properties of a modified Brooke ileostomy: justification for retaining the most distal ileum

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• 作者：Martha Quinn (1)
  Isabell Robertson (1)
  Mary Speirs (1)
  Vlad Shumeyko (1)
  Praveen Sharma (1)
  Angus Macdonald (1)
  
• 关键词：Ileostomy ; Ileocolic sphincter ; Terminal ileum
• 刊名：International Journal of Colorectal Disease
• 出版年：2013
• 出版时间：July 2013
• 年：2013
• 卷：28
• 期：7
• 页码：973-975
• 全文大小：98KB
• 参考文献：1. Brooke BN (1952) The management of ileostomy including its complications. Lancet 2:102- CrossRef
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• 作者单位：Martha Quinn (1)
  Isabell Robertson (1)
  Mary Speirs (1)
  Vlad Shumeyko (1)
  Praveen Sharma (1)
  Angus Macdonald (1)
  
  1. Department of Surgery, Monklands Hospital, Monkscourt Avenue, Airdrie, ML6 0JS, UK
  

文摘

Purpose The traditional Brooke ileostomy removed the last 8-5?cm of the ileum due to concern of occurrence of terminal ileal Crohn’s disease, vide infra the ileocolic sphincter was removed. Retaining all the terminal ileum has the potential of retaining the ileocolic sphincter. Our aim was to investigate whether a high-pressure zone existed within the last few centimetres of the ileum and its response to pharmacological stimuli. Methods A balloon manometry catheter was introduced into the stoma of 16 patients who had formation of an end ileostomy (ileocolic sphincter retained, ICS). Recordings were made at 1?cm intervals from the meatus in order to identify the maximum intra-luminal resting and intra-abdominal pressure. At the point of maximum resting pressure, the response to phenylephrine (10?% gel) and glyceryl trinitrate (GTN) (0.2?% paste) was recorded. Results were recorded using an Ohmeda Oestiva 5 manometry system (in millimeter of mercury) and data were analysed using ANOVA. Results were compared with 13 historical controls (ileocolic sphincter removed). Results There was no significant difference in resting intra-abdominal pressure between the two groups (historical controls 8.5?±-.0?mmHg; ICS 9.0?±-.2?mmHg), p-?NS. The maximum resting intra-luminal pressure in ICS patients exceeded historical controls 16?±-.9 vs 10.0?±-.5?mmHg, p-lt;-.001. In ICS patients, phenylephrine increased the resting pressure to 26.0?±-.5?mmHg, p-lt;-.001. In historical controls, the pressure remained unchanged, 12?±-.7?mmHg, p-?NS. Subsequent addition of GTN to both groups lowered maximum intra-luminal pressure to pre-study values, 10?±-.2?mmHg (ICS) and 7?±-.5?mmHg (controls), p-?NS. Conclusion Retention of the ileocolic sphincter in a modified Brooke ileostomy preserves a physiological high-pressure zone, the properties of which can be modified by pharmacological agents.