Ileal neoappendicostomy for antegrade colonic irrigation P. Christensen, S. Buntzen, K. Krogh and S. Laurberg Surgical Research Unit, Department of Surgery L, Section AAS, University Hospital of Aarhus, Aarhus, Denmark Correspondence to: Dr P. Christensen, Surgical Research Unit, Department of Surgery L, Aarhus Amtssygehus, Tage Hansens Gade 2, DK-8000 Aarhus C, Denmark e-mail: Piz@dadlnet.dk) Paper accepted 31 August 2001 Introduction The use of an appendicostomy for administration of antegrade enemas has proven to be safe and effective in selected patients with faecal incontinence and constipa- tion 1±3 . When the appendix is not available a number of othertechniqueshavebeenusedtocreateasubstitutefor the appendix 1,2,4,5 . However, the morbidity with these proceduresisconsiderable,includingleakageofmucusor faeces and stomal stenosis. The aim of this study was to evaluatepreliminaryresultswithanewilealneoappendic- ostomy. Patients and methods Surgical technique Theterminalileumisdividedwithan80-mmGIAstapling deviceUSSC,NorthHaven,Connecticut,USA).A12-Fr ballooncatheterisintroducedthroughtheileocaecalvalve intothecaecumviaasmallincisionatthemesentericborder ofthedivideddistalterminalileum.Theballoonisin¯ated tohelpidentifytheileocaecalvalve.Thecalibreofthedistal terminal ileum is reduced by resection along the anti- mesentericborder,preservingtheileocaecalvalveFig. 1). An ileocolonic anastomosis is made from the proximal terminalileumandtheascendingcolon.Theilealconduitis exteriorized using a V±Y plasty in the skin 2 . Finally, the caecum is sutured to the back of the anterior abdominal wall.Followingtheprocedure,a10-Frsiliconecatheteris left in situ for2weeks. Patients From September 1999 to November 2000 nine patients withseverecolorectaldysfunctionunderwenttheoperation as described all women; median age 50 range 29± 69) years). All patients were followed prospectively. In three patients a sigmoid colostomy was added to the procedure. Five patients had been incontinent to solid stools daily or several times per week. In two of these patients, faecal incontinence was the result of spinal cord injury,intwopatientstherewasanalsphincterinsuf®ciency andinonepatientincontinencefollowedsurgeryforrectal prolapse.Fourpatientssufferedfromsevereconstipation. Results Afteramedianfollow-upof10range3±20)months,eight ofninepatientsstillusedtheilealneoappendicostomy.In two patients the neoappendicostomy was completely continent.Sixpatientshadminorliquidre¯ux,twopatients hadsmallleakageofgas,andtwopatientscomplainedofa periodic bad smell from the ileal conduit. All patients coveredthestomawithasimplewoundbandage.Thestoma waseasytocatheterizeinsixpatients,narrowinonepatient, andonepatienthadastenosisoftheilealconduitrequiring dilatation under general anaesthesia. To prevent further trouble a gastrotomy tube MIC-KEY; Ballard Medical Products,Draper,Utah,USA)wasinserted. With regular antegrade colonic irrigation faecal incon- tinence was either absent or very much reduced, and constipation was treated successfully in three of four patients.Onepatienthadanunsatisfactoryresultfromthe irrigationprocedure.Fourpatientsreportedtransientside- effects during washout such as chills, mild abdominal Fig. 1 Theterminalileumisdividedapproximately6cmfrom theileocaecalvalve.Theproximalpartoftheterminalileumis situatedtotheleft.A12-Frcatheterisintroducedviathedistal partoftheterminalileumthroughtheileocaecalvalveintothe caecum.Theballoonisin¯atedtohelpidentifytheileocaecal valve.Thecalibreofthedistalterminalileumisreducedby resectionalongtheantimesentericborder.Attheileocaecal junctiontheantimesentericpartoftheterminalileumis resected,preservingtheileocaecalvalve Short note ã 2001 Blackwell Science Ltd British Journal of Surgery 2001, 88, 1637±1638 1637