EFFECT OF TERMINAL ILEAL TRANSPOSITION ON GALLBLADDER BITE COMPOSITION FOLLOWING PROCTOCOLECTOMY

Enterohepatic circulation of bile acid is impaired and the percentage of secondary bile acids in bile decreases after proctocolectomy and il eo-anal anastomosis. Moreover, the site-specific function and morpholo gy of the terminal ileum are likely to be damaged by acute and chronic inflammation because the ileum is being used as a reservoir in this p rocedure. Ajejunal segment was interposed between the terminal ileum a nd the anus to spare the terminal ileum from being used as a reservoir following proctocolectomy in dogs. We performed this study to investi gate the effects of this procedure on gallbladder bile lipid compositi on. Adult mongrel dogs underwent either terminal ileal transposition p rocedure (n = 7) or conventional ileoanal anastomosis (n = 7) followin g two-stage proctocolectomy. The animals were laparotomized and gallbl adder bile was collected 12 weeks later. In the terminal heal transpos ition group, the total. bile acid concentration significantly decrease d (P < 0.01), while the secondary bile acid percentage did not. In the conventional group, the percentage of secondary bile acid significant ly decreased (P < 0.05), while the total bile acid concentration remai ned unchanged. Proximal transposition of the terminal ileum may have a n advantage in preserving the percentage of secondary bile acid in gal lbladder bile. This procedure effects bile lipid metabolism differentl y than conventional ileo-anal anastomosis. (C) 1996 Academic Press, In c.