Comparison of endorectal ileal pullthrough following colectomy with and without ileal reservoir

In an experimental study, 18 dogs underwent total colectomy, mucosal proctectomy, and endorectal ileal pullthrough with ileoanal anastomosis. In 6 dogs, no internal reservoir was constructed (NR). In 6 additional dogs, an S-shaped ileal reservoir (SR) was constructed immediately above the peritoneal reflection. In 6 other dogs, a side-to-side ileal reservoir (SS) of 15-cm length was constructed above the peritoneal reflection. At 12 wk postoperatively, there was a 231% increase in volume of the SS reservoir, whereas the SR increased 85% and the NR increased 78%. Dogs with NR experienced high stool frequency with low water absorption and minimal dilatation. Dogs with SR experienced dilatation rapidly, reducing stool frequency but causing stasis and moderate to severe inflammation of the ileal mucosa. Dogs with SS of at least 15-cm length enlarged sufficiently to reduce stool frequency and increase water absorption slightly without causing stasis or appreciable inflammation.