Ileoanal anastomosis with proximal ileal reservoir: an experimental study

Endorectal ileoanal anastomosis with proximal interposition of an ileal reservoir was evaluated experimentally in dogs as an approach to retain sphincteric control of defecation after proctocolectomy. Two months after the operative procedure, eight animals with a reservoir had four to eight semisolid stools per day and were continent. In contrast, six animals with straight ileoanal anastomosis were incontinent with 10 to 14 evacuations per day. Motility studies demonstrated a reduction of propulsive peristalsis within the undistended reservoir, which is considered the responsible factor for increased intestinal transit time and reduced stool frequency. Filling of the reservoir to capacity elicited strong peristaltic contractions, which may assure a more complete evacuation of the reservoir during defecation. Reservoir capacity increased substantially (150% to 200%) within 2 months but only to a minor degree thereafter, indicating that the reservoir does not dilate progressively into an atonic viscus. Motility patterns remained unaltered as the reservoir became more complaint with time. Mucosal alterations (flattening of villi, submucosal inflammation) were detected in the reservoir but did not result in nutritional defects within an observation period of 1 year.