[An elastic ileostomy sphincter using an autologous small intestine muscle flap]

To achieve continence in ileostomies by free transplantation of small intestinal smooth muscle according to Schmidt failed frequently because of hemorrhagic necrosis of this graft. To safeguard intact vascularisation of the transplant flapped intestinal smooth muscle was used therefore in 15 dogs with ileostomy for sphincter replacements. Contrary to free grafts, histological studies of flapped small intestinal muscle cuffs show generally undisturbed healing. Furthermore, monitoring of electrical activities corroborate the viability of the graft. In continent animals, pressure studies show the presence of a high pressure zone in the sphincter canal. The positive pressure profile was maintained and contributes to appropriate closing of the ileostomy. Despite histological, manometrical and electrical criterions of viability of the artificial sphincter, nevertheless the continence achieved by this procedure remains limited because of the restricted ability to contract the small intestinal muscle and the lacking ileal compliance.