ILEOCECAL VALVE RECONSTRUCTION DURING CONTINENT URINARY-DIVERSION

During construction of an ileocecal reservoir, such as the Mainz or In diana pouch, the ileocecal valve is lost. Subsequently, the intestinal transit time is shortened and malabsorption as well as diarrhea may r esult. Patients having undergone previous bowel resection as well as c hildren with myelomeningocele who often already have frequent defecati ons will be heavily affected by the loss of the ileocecal valve. We ha ve functionally reconstructed the ileocecal valve by embedding ileum i nto the ascending colon via a submucosal tunnel in analogy to the tech nique used when creating the continence mechanism during the Mainz pou ch procedure using the appendix. Experimental results in 15 dogs demon strated that the surgically reconstructed valve genuinely mimics the p hysiological function of the authentic valve and confirmed a marked tr ansit time prolongation without evidence of obstruction. Our first cli nical experience in 12 patients using this operative technique is prom ising. Equally, the morphological appearance of the newly created valv e closely resembles the genuine ileocecal valve during barium enema as well as endoscopic investigations.