Antiperistaltic ileostomy using the long terminal ileal segment

PURPOSE: This study was undertaken to determine whether reversed terminal i leal segments can be used to decrease ileostomy output in patients who have undergone total proctocolectomy and ileostomy for ulcerative colitis or fa milial adenomatous polyposis. METHODS: An approximately 25-cm length of ter minal ileum was reversed in an antiperistaltic manner, and the new terminal ileal end was used for the ileostomy constructed in the usual manner. Six patients underwent this procedure and were compared with six patients who h ad conventional total proctocolectomy and ileostomy. Variables studied incl uded weight of ileostomy output and the weight of the filtered fluid compon ent. Data were obtained on seven different occasions during a two-month per iod beginning three months after the operation. Analysis was done using Stu dent's t-test. RESULTS: There was a statistically significant decrease in t he weight of the average 24-hour ileostomy effluent in those patients under going reversed antiperistaltic loop procedures. There was also a statistica lly significant decrease in the filterable liquid proportions. CONCLUSIONS: The antiperistaltic ileostomy is effective in reducing the daily amount of ileostomy effluent and facilitates stoma care, owing to its diminished liq uid component.