J.Jpn. Surg. Soc.. 82(6): 549-565, 1981

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Original article

STUDY ON THE SMALL BOWEL TRANSIT TIME AND PHYSIOCHEMICAL CHARACTERISTICS OF THE ILEAL EXCRETA IN ABDOMINAL AND ANAL ILEOSTOMY

A new procedure for ileoanostomy with total colectomy and mucosa! proctectomy has been established by J. Utsunomiya et al. In this operation, the rectal mucosa is removed from the level just below the promontory to that just above the dentate line. The ileoanal anastomosis, anal ileostomy is performed either by simple end to end anastomosis or side to end anastomosis on the bottom of the loop type reservoir. The temporal diverting loop ileostomy is performed using the ileal loop 50 to 60 cm appart from the end for protecting the ileoanal anastomosis; it is closed later than three months after the operation to let the ileal content pass through the natural anus. (The second stage operation.) The operation have been performed on 10 cases with ademomatosis, 2 cases with colitis. In 12 cases,the procedure has been completed by closing the loop ileostomy.
The defecation function is satisfactory in most of the cases. The ileal excreta from the anal ileostomy becomes to the formed from the mushy character of that of the abdominal ileostomy.
The mechanism of this phenomenon was studied in follows.
1) The small bowel transit time evaluated by the radioopaque markers method was 6 hours and 17 minutes before the operation. After the first stage operation, the transit time to the loop ileostomy stoma was estimated to be about 4 hours in an average. It was remarkably prolonged and yielded the average value of 15 hours and 8 minutes, when the ileostomy was closed.
2) The daily volume of output as well as sodium and water content of the ileal excreta from the stoma or anus were found to decrease and the amount of anaerobic bacteria increase proportionally to prolongation of the small bowel transit time.
3) Daily output of sodium and chloride in the ileal excreta from the abdominal ileostomy as well as anal ileostomy was continuously above the amount excreted in the feces before the colectomy; potassium output of the ileostomies was below that of t:he feces.
4) The ileal content from the anal ileostomy showed significantly less daily output of volume, sodium, water content and Na/K ratio comparing with that from the abdominal ileostomy.
5) The daily output of sodium showed a close positive relationship with the volume of ileal excreta.
These results indicate that because our procedure has adequately long small transit time which decreases the daily output of water and sodium in the ilea! excreta and increases the amount of anaerobic bacteria, most of our patients have less daily output of feces and satisfactory defecation function.

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