AN INTESTINAL NEOSPHINCTER ATTAINED BY ME ANS OF CIRCUMSCRIBED MUSCLEPROLIFERATION - DEVELOPMENT OF THE TECHNIQUE AND EVALUATION OF FUNCTION IN DOGS

In an experimental study an intestinal neosphincter (INS) was construc ted by modifying the principle of the ileocolic nipple-valve anastomos is by means of ultrasonic tissue fragmentation of the contacting seros a of the ileum and the corresponding mucosa of the ileum and colon. Th e healing of the muscle layers was studied histologically. The functio n of the INS was investigated in six dogs and compared intraindividual ly with that of the ileocecal valve and conventional end-to-end anasto mosis. Morphologically the neospincters healed within 3 months without major fibrosis. The reference values of the aerobic and anaerobic bac terial counts in the terminal ileum were more than 2 logs lower than i n the colon with the normal ileocecal valve, and after ileo-colonic en d-to-end-anastomosis bacterial colonization of the terminal ileum was found both qualitatively and quantitatively. Subsequent interposition of the INS led to bacterial clearance of the terminal ileum. The media n aerobic bacterial counts were lower by six logs and the an aerobic b acterial counts by 3 logs than in the colon. However, differences were not statistically significant owing to the wide variation in the indi vidual values. Nevertheless, the demonstrable clearance of the termina l ileum could be explained by the orthograde passage with absolutely n o stagnation and the relative competence of the INS in resisting retro grade pressure competence. In conclusion, ultrasonic fragmentation of the serosa and mucosa of the bowel allows construction of an INS from three muscle layers, which acts as a bacteriological barrier. Before i t is introduced into the clinical setting its integration into the int estinal motility should be evaluated by further studies.