Ileocecal reservoir reconstruction after total mesorectal excision: functional results of the long-term follow-up

Abstract

Functional results and subjective assessment of ileocecal interposition were constant at 3 and 5 years postoperatively. If construction of a colonic J-pouch is not possible due to lack of colonic length, especially after prior colonic resections, the ileocecal interpositional reservoir may offer an alternative to rectal replacement.

Modified Ileocecal Interposition – The Final Sphincter-Saving Solution after Failed Salvage Surgery for Anastomotic Complications of Low Anterior Resection

“…In the initial reports, ileocecal interposition seemed to achieve the same quality of continence, but seemed to be superior with respect to defecation quality [5, 6]. However, long-term results did not reveal better evacuation, as more than 50% of the patients were complaining of fragmentation after 5 years [17]. Our randomized trial demonstrated similar functional outcomes after 5 years, but at 1 year, patients with ileocecal interposition tended to have a higher frequency of defecation than patients with a colon-J-pouch [18].…”

“…Furthermore, postoperative radiotherapy may cause severe complications after ileocecal interposition, namely complete occlusion of the interposed ileal segment [19]. Thus, the two teams who have reported on this method do not recommend it as a first-choice treatment [17, 18]. …”

The colon J-pouch as a cause of evacuation disorders after rectal resection: myth or fact?

“…Reduction of the pouch size to a maximum limb length of 5-6 cm is likely to reduce the incidence of the evacuating problems [9,10], but in some studies, even if a limb length of 6 cm or less was chosen, up to one half of the patients experienced at least some kind of evacuating difficulty [11,12]. The transverse coloplasty pouch (TCP) [13,14] and the ileocecal interposition (ICI) [15,16] have also been introduced as alternative methods to overcome this problem, but long-term data from ICI also demonstrate evacuation disorders in a substantial proportion of the patients [16,17], and long-term data on TCP are not yet available. On the other hand, evacuation difficulties have also been described after low anterior resection and SCA in up to one third of patients [6,18,19].…”

Colonic Reservoirs in Patients After Rectal Resection

“…Ileo-cecal reservoirs should be considered in patients with diverticulosis of the descending colon and sigmoid and whenever hypertrophic, lipomatous mesocolon and narrow pelvis are encountered. The merit of this method is said to be preservation of afferent and efferent innervation (54,55). For this method, functional outcomes after 3 and 5 years of observation are not significantly different from those obtained in patients with the JP pouch (54).…”