Multi-institutional experience with the gastrointestinal composite reservoir

Purpose: We evaluated multi-institutional experience with the gastrointesti nal composite reservoir in patients with metabolic acidosis, the short bowe l syndrome, severe pelvic radiation and/or renal insufficiency. Materials and Methods: At 4 institutions 33 patients underwent construction of a gastrointestinal composite reservoir, including 19 with the short bow el syndrome, 13 with metabolic acidosis and 7 who also had renal insufficie ncy. A total of 16 patients underwent conversion of a previous diversion an d the remaining 17 received new urinary diversion. Charts were reviewed for the metabolic impact of the gastrointestinal reservoir as well as any long -term sequelae. Results: At a mean followup of 54 months there was a significant (p less th an or equal to0.05) improvement in mean preoperative and postoperative seru m chloride (106 versus 102 mEq./l.), serum bicarbonate (23.3 versus 25 mEq. /l.) and serum pH (7.36 versus 7.4). Mean serum creatinine did not signific antly differ during followup in patients with normal renal function or rena l insufficiency. Complications were not different than those of standard in testinal or gastric reservoirs. Conclusions: The gastrointestinal reservoir has provided an excellent metab olic balance in a large series of compromised patients with few side effect s. We believe that the gastrointestinal composite reservoir represents the urinary diversion of choice when standard intestinal urinary reservoirs can not be created in the setting of metabolic acidosis, the short bowel syndro me and severe pelvic radiation. However, the value of the gastrointestinal composite in the setting of renal insufficiency remains undetermined.