BIOMECHANICAL STABILIZATION OF THE NIPPLE VALVE IN CONTINENT ILEOSTOMY

Despite stapler stabilization, sliding complications of nipple valve f unction occur in 19 per cent of continent ileostomies. Because the ten dency of the ileum to desuscept is triggered by traction forces on the mesentery of the nipple during filling of the reservoir, a technique was developed to neutralize this biomechanical strain. In addition, to obtain fibrous healing between the muscular layers, the mucosa of con tacting intestinal walls was removed by selective ultrasonic fragmenta tion. The valves of 18 consecutive patients were operated on with this technique. In six of these, a sliding valve was restabilized in a med ian time of 1.2 (range 0.4-2.9) years after conventional construction of the pouch, All are functioning well after a median of 4.6 (range 3. 0-6.0) years. Between 1.8 and 4.8 years after operation a healed area between the musculature of the nipple and pouch of 4.5-7.2 cm(2) was s hown by endosonography. This procedure may provide long-term preventio n of sliding complications in continent ileostomies.