THE BACTERIAL CLEARANCE OF THE TERMINAL I LEUM IN CORRELATION TO THE ILEOCOLIC CONNECTION

The ecology of the (neo-)terminal ileum was investigated in three grou ps of mongrel dogs (group 1 to 3; 6 animals per each group) depending on the ileocolic connection and the resection of the terminal ileum. T he efficacy of a stabilized nipple-valve-anastomosis (SNVA) was evalua ted comparing the physiological ileocecal valve and the conventional e nd-end-anastomosis. The relations of the aerobic and anaerobic bacteri al counts of all 18 dogs (group 0) preoperatively served as reference- values. Under this physiological condition the median counts were foun d to be lower in the ileum than in the colon, two logs for the aerobic bacteria and three logs for the anaerobic bacteria, confirming statis tical significance (p not less than or equal to 0.05). The resection o f the terminal ileum conserving the ileocecal valve (group 1) had no i nfluence on the bacterial flora of the neoterminal ileum, whereas the limited resection of the ileocecal valve with ileocolic end-end-anasto mosis (group 2) induced a bacterial colonisation of the terminal ileum . In contrast, following wide ileocoecal resection and replacement of the ileocecal valve by the SNVA (group 3) the bacterial counts were lo wer in the terminal ileum than in the colon: five logs for aerobic and seven logs for anaerobic bacteria. This difference was statistically significant within this group between ileum and colon and between ileu m preoperatively and postoperatively (p less than or equal to 0,05). I n conclusion, the bacterial clearance of the (neo-)terminal ileum depe nds more on the retrograde barrier-function of the ileocecal valve or an appropriate mechanical substitute than on the propulsive motility o f the ileum. This may be explained by retrograde motor-complexes in th e colon, in consequence of which the SNVA compared with the ileocecal valve leads to an ecological overcorrection due tu absolute retrograde pressure-competence. The technical improvement of the nipple valve an astomosis by a special zone of stabilization seems to be crucial for s uccessful clinical use.