A Prospective Randomized Comparison of Two Different Pelvic Pouch Designs

Abstract

The clinical, manovolumetric, and functional results of restorative proctocolectomy were studied in patients randomly allocated to construction of either a J-shaped pouch (n = 29) or a pouch fashioned by the folding technique used for the Kock continent ileostomy (K-pouch) (n = 26). A complete endoanal mucosectomy was performed, and the pouches were all constructed from 30-cm lengths of ileum. There were no deaths and no significant difference in postoperative morbidity. Anal pressures were equal in the two groups. The K-pouch expanded more favourably postoperatively, and its volume at 1 year was significantly greater than that of the J-pouch (355 ± 71 ml (SD); range, 225–95, versus 264 ± 81 ml; range, 75–440; p < 0.001). The pouches had similar motility patterns and sensory pressure thresholds. Initially after closure of the loop ileostomy there was a tendency for better functional outcome in K-pouch patients. At 1 year the overall distribution of functional defects did not differ, and the defaecation frequency was about equal in the groups.

Key Words:

• Manovolumetry
• pelvic ileal pouch
• ulcerative colitis