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. 1997 Dec;226(6):746–752. doi: 10.1097/00000658-199712000-00011

Ileocecal segment transposition does not alter whole gut transit in humans.

L P Degen 1, M O von Flüe 1, A Collet 1, C Hamel 1, C Beglinger 1, F Harder 1
PMCID: PMC1191150  PMID: 9409573

Abstract

OBJECTIVES: We have recently described a reservoir for rectal replacement after total mesorectal excision for rectal carcinoma. The ileocecal segment with its intact extrinsic nerve and blood supply is placed between the ascending colon and the anal canal. This reconstruction has been shown to provide good defecation quality and anorectal function. Whether gastric emptying and small as well as large bowel transit are affected by this transposition remains unclear. Our aim was to quantify whole gut transit in such patients and compare it with that of a matched group of controls. METHODS: Gastric emptying rates and small intestinal and colonic transit times were assessed scintigraphically in 12 patients aged 46 to 87 years with ileocecal reservoir reconstruction after total mesorectal excision and compared to a sex-matched group of asymptomatic healthy volunteers of similar age. Gastric emptying rates and small intestinal and colonic transit times were calculated as described previously. Data were compared using Wilcoxon's signed rank test for gastric emptying rates and small bowel transit or by analysis of variance for colonic transit; p < 0.05 was considered significant. RESULTS: Gastric time for half of the meal (T50) was 161 +/- 16 minutes for patients and 201 +/- 22 for the controls. Small bowel transit time was 150 +/- 15 minutes for patients and 177 +/- 22 for the controls. Geometric center at 6 hours was 1.53 +/- 0.13 for patients and 1.27 +/- 0.16 for the controls. Geometric center at 24 hours was 2.96 +/- 0.23 for patients and 2.57 +/- 0.25 for the controls. Data are mean +/- SEM. Summary: Gastric emptying rates and small bowel transit and colonic transit times (expressed as geometric center at 6 and 24 hours) were similar in patients with ileocecal reservoir reconstruction and in a sex- and age-matched group of healthy controls. We conclude that the transposition of an ileocecal segment with intact extrinsic neurovascular supply between the sigmoid colon and the anal canal does not alter whole gut transit, not even in any of the presumably key regions.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Camilleri M., Colemont L. J., Phillips S. F., Brown M. L., Thomforde G. M., Chapman N., Zinsmeister A. R. Human gastric emptying and colonic filling of solids characterized by a new method. Am J Physiol. 1989 Aug;257(2 Pt 1):G284–G290. doi: 10.1152/ajpgi.1989.257.2.G284. [DOI] [PubMed] [Google Scholar]
  2. Camilleri M., Zinsmeister A. R., Greydanus M. P., Brown M. L., Proano M. Towards a less costly but accurate test of gastric emptying and small bowel transit. Dig Dis Sci. 1991 May;36(5):609–615. doi: 10.1007/BF01297027. [DOI] [PubMed] [Google Scholar]
  3. Camilleri M., Zinsmeister A. R. Towards a relatively inexpensive, noninvasive, accurate test for colonic motility disorders. Gastroenterology. 1992 Jul;103(1):36–42. doi: 10.1016/0016-5085(92)91092-i. [DOI] [PubMed] [Google Scholar]
  4. Faussone Pellegrini M. S., Manneschi L. I., Manneschi L. The caecocolonic junction in humans has a sphincteric anatomy and function. Gut. 1995 Oct;37(4):493–498. doi: 10.1136/gut.37.4.493. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Fich A., Steadman C. J., Phillips S. F., Camilleri M., Brown M. L., Haddad A. C., Thomforde G. M. Ileocolonic transit does not change after right hemicolectomy. Gastroenterology. 1992 Sep;103(3):794–799. doi: 10.1016/0016-5085(92)90008-m. [DOI] [PubMed] [Google Scholar]
  6. Greydanus M. P., Camilleri M., Colemont L. J., Phillips S. F., Brown M. L., Thomforde G. M. Ileocolonic transfer of solid chyme in small intestinal neuropathies and myopathies. Gastroenterology. 1990 Jul;99(1):158–164. doi: 10.1016/0016-5085(90)91243-y. [DOI] [PubMed] [Google Scholar]
  7. Johansson H., Nylander G. Analysis of the ileocaecal emptying mechanism in the rat. Acta Chir Scand. 1968;134(3):296–302. [PubMed] [Google Scholar]
  8. Johansson H., Nylander G. Ileo-colic transit in rats subjected to ileo-caecal resection. Acta Chir Scand. 1969;135(5):455–458. [PubMed] [Google Scholar]
  9. Lundqvist H., Jung B., Gustavsson S., Nilsson F., Lundqvist G. Analyses of small bowel propulsion, ileo-caecal passage and serum gastrin after truncal vagotomy. A methodological study in the rat with continuous intraduodenal infusion. Acta Chir Scand. 1975;141(4):298–303. [PubMed] [Google Scholar]
  10. MacFarlane J. K., Ryall R. D., Heald R. J. Mesorectal excision for rectal cancer. Lancet. 1993 Feb 20;341(8843):457–460. doi: 10.1016/0140-6736(93)90207-w. [DOI] [PubMed] [Google Scholar]
  11. Nasmyth D. G., Williams N. S. Pressure characteristics of the human ileocecal region--a key to its function. Gastroenterology. 1985 Aug;89(2):345–351. doi: 10.1016/0016-5085(85)90335-x. [DOI] [PubMed] [Google Scholar]
  12. Neal D. E., Williams N. S., Barker M. C., King R. F. The effect of resection of the distal ileum on gastric emptying, small bowel transit and absorption after proctocolectomy. Br J Surg. 1984 Sep;71(9):666–670. doi: 10.1002/bjs.1800710906. [DOI] [PubMed] [Google Scholar]
  13. Neri M., Phillips S. F., Fich A., Haddad A. C. Canine ileocolonic sphincter: flow, transit, and motility before and after sphincterotomy. Am J Physiol. 1991 Feb;260(2 Pt 1):G284–G289. doi: 10.1152/ajpgi.1991.260.2.G284. [DOI] [PubMed] [Google Scholar]
  14. Phillips S. F., Quigley E. M., Kumar D., Kamath P. S. Motility of the ileocolonic junction. Gut. 1988 Mar;29(3):390–406. doi: 10.1136/gut.29.3.390. [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. Proano M., Camilleri M., Phillips S. F., Brown M. L., Thomforde G. M. Transit of solids through the human colon: regional quantification in the unprepared bowel. Am J Physiol. 1990 Jun;258(6 Pt 1):G856–G862. doi: 10.1152/ajpgi.1990.258.6.G856. [DOI] [PubMed] [Google Scholar]
  16. Quigley E. M., Borody T. J., Phillips S. F., Wienbeck M., Tucker R. L., Haddad A. Motility of the terminal ileum and ileocecal sphincter in healthy humans. Gastroenterology. 1984 Oct;87(4):857–866. [PubMed] [Google Scholar]
  17. Quigley E. M., Phillips S. F., Dent J., Taylor B. M. Myoelectric activity and intraluminal pressure of the canine ileocolonic sphincter. Gastroenterology. 1983 Nov;85(5):1054–1062. [PubMed] [Google Scholar]
  18. Soper N. J., Chapman N. J., Kelly K. A., Brown M. L., Phillips S. F., Go V. L. The 'ileal brake' after ileal pouch-anal anastomosis. Gastroenterology. 1990 Jan;98(1):111–116. doi: 10.1016/0016-5085(90)91298-k. [DOI] [PubMed] [Google Scholar]
  19. Spiller R. C., Brown M. L., Phillips S. F. Emptying of the terminal ileum in intact humans. Influence of meal residue and ileal motility. Gastroenterology. 1987 Mar;92(3):724–729. doi: 10.1016/0016-5085(87)90024-2. [DOI] [PubMed] [Google Scholar]
  20. Spiller R. C., Trotman I. F., Higgins B. E., Ghatei M. A., Grimble G. K., Lee Y. C., Bloom S. R., Misiewicz J. J., Silk D. B. The ileal brake--inhibition of jejunal motility after ileal fat perfusion in man. Gut. 1984 Apr;25(4):365–374. doi: 10.1136/gut.25.4.365. [DOI] [PMC free article] [PubMed] [Google Scholar]
  21. Stivland T., Camilleri M., Vassallo M., Proano M., Rath D., Brown M., Thomforde G., Pemberton J., Phillips S. Scintigraphic measurement of regional gut transit in idiopathic constipation. Gastroenterology. 1991 Jul;101(1):107–115. doi: 10.1016/0016-5085(91)90466-x. [DOI] [PubMed] [Google Scholar]
  22. Vassallo M., Camilleri M., Phillips S. F., Brown M. L., Chapman N. J., Thomforde G. M. Transit through the proximal colon influences stool weight in the irritable bowel syndrome. Gastroenterology. 1992 Jan;102(1):102–108. doi: 10.1016/0016-5085(92)91789-7. [DOI] [PubMed] [Google Scholar]
  23. von Flüe M. O., Degen L. P., Beglinger C., Hellwig A. C., Rothenbühler J. M., Harder F. H. Ileocecal reservoir reconstruction with physiologic function after total mesorectal cancer excision. Ann Surg. 1996 Aug;224(2):204–212. doi: 10.1097/00000658-199608000-00014. [DOI] [PMC free article] [PubMed] [Google Scholar]
  24. von Flüe M., Harder F. New technique for pouch-anal reconstruction after total mesorectal excision. Dis Colon Rectum. 1994 Nov;37(11):1160–1162. doi: 10.1007/BF02049823. [DOI] [PubMed] [Google Scholar]

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