부산대학교 도서관

Background: The functional results of straight and colonic J-Pouch anastomoses after very low anterior rectal resection didn't fulfill our expectations concerning defecation and lifequality. So we applied the concept of ileocecal interposition presented by von Flue & Harder [9] in 1994 in 15 patients. Patients and Methods: From October 1997 to October 1999 we performed in 15 patients (twelve males/three females) an ileocoecal interposition following a very low anterior rectal resection. The average age was 65.5 years (45-81 years). One patient avoided control. 14 out of those 15 patients were controlled retrospectively for functional results (fecal continence and stool behaviour). Results: The statements of one patient couldn't be taken into account because of a dementia. 13 patients were evaluated. Postoperatively three patients showed excellent fecal continence, four patients suffered from first-degree fecal incontinence (uncontrolled flatus) and six patients had a second-degree fecal incontinence (incontinent for liquid stools). Six patients complained about urge symptoms, five about incomplete evacuation. Discrimination was clearly reduced in six cases, one patient couldn't discriminate at all.Three patients permanently relied on nappy liners. Four patients felt a clear impeding of their lifequality. Conclusions: To our experience the concept of ileocecal interposition is an acceptable alternative to current reconstructions in very low anterior rectal or coloanal anastomoses. We couldn't detect any functional superiority in our admittedly small number of patients. To our opinion the neurovascular intact pedicle, the unnecessity of left colonic flexur mobilisation and a functional result comparing to that after J-pouch reconstruction are advantageous. Because of comparable functional results since 2000 we reconstruct predominantly using a longitudinal transversal coloplasty-pouch. As indication for an ileocecal interposition we regard furtheron a local recurrence with a short colonic remnant, a previous sigmoid resection, the transformation of a straight reconstruction as ultimate alternative to a permanent stoma in case of a bad functional result and eventually a hostile abdominal situation with difficult mobilisation of the left colonic flexur.