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[Pseudocontinent colostomy - a manometric study].

D Kostov, T Temelkov, K Ivanov

    Khirurgiia
    |May 25, 2002
    PubMed
    Summary

    A modified smooth muscle muff transplant effectively creates resistance in the colon, preventing spontaneous evacuation in patients with continent colostomy. This surgical technique establishes functional isolation in the terminal colon segment.

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    Area of Science:

    • Colorectal Surgery
    • Surgical Innovation
    • Gastrointestinal Physiology

    Background:

    • Rectal extirpation often necessitates colostomy, impacting bowel function.
    • Continent colostomy aims to improve patient quality of life by controlling evacuation.
    • Maintaining continence requires adequate resistance in the terminal colon segment.

    Purpose of the Study:

    • To evaluate the intraluminal pressure and resistance created by a transplanted smooth muscle muff in continent colostomy.
    • To assess the functional efficacy of a modified Schmidt's pattern smooth muscle muff in preventing spontaneous colonic evacuation.

    Main Methods:

    • Manometric measurement of intraluminal pressure in the terminal colon segment of 42 patients with a transplanted smooth muscle muff.
    • Pressure recordings were taken at rest and after mechanical dilatation of the muff.

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  • Comparison with a control group of 20 patients with continent colostomy without muff transplantation.

    • Main Results:

    • Basal intraluminal pressure in patients with the smooth muscle muff was significantly higher (30 +/- 2.9 mmHg) compared to controls.
    • This elevated pressure, indicative of resistance, was sustained long-term (29.7 +/- 3.0 mmHg up to two years post-surgery).
    • Pressure increased to 42 +/- 2.5 mmHg after dilatation, demonstrating the muff's functional capacity for isolation.

    Conclusions:

    • The transplanted smooth muscle muff effectively creates a functional index of resistance in the terminal colon.
    • This resistance is directly dependent on the smooth muscle muff's functional potential, successfully isolating the colonic segment.
    • The modified muff demonstrates significant functional activity, crucial for achieving fecal continence after rectal surgery.