대한대장항문학회

Purpose: To evaluate the effectiveness of a P-pouch configuration with a reservoir and recycled segment in restorative proctocolectomy. Methods: There were 11 patients who underwent the P-pouch procedure. They were compared with healthy eight-control subjects. The P-pouch configuration was constructed using one firing of a 10 cm GIA stapler to form a 12-cm reservoir. Following that, the distal ileum (15⁑0.5 cm) was anastomosed to the proximal portion of the pouch. Pouch function was studied 23.3⁑4.4 months after ileostomy closure. We measured the frequency and amount of stool. The postprandial plasma peptide YY (PYY) response and the scintigraphic studies using 99m-Tc sulfur colloid were used to study transit. Results: In the patient group, daily stool frequency and volume were 5.2⁑0.3 and 423.5⁑23.7 g, respectively. Stool seepage and pouchitis occurred in 45.5 % and 9.1%. In contrast to other pouch procedures, the postprandial increment of plasma PYY was similar the P-pouch patients and healthy controls (P＞0.05). The integrated increment of plasma PYY for 180 minutes following meals was also not decreased in 9-pouch patient group compared with the healthy controls (1,050.0⁑127.8 pmol/l vs. 1146.0⁑150.0 pmol/l, P＞0.05). Small intestinal transit time for healthy controls and the patient group averaged 89⁑21 and 117⁑12 minutes (P＞0.05). The capacity of the ileal pouch was 372⁑22 ml, and the efficiency of ileal reservoir evacuation was 76 %. Conclusions: The P-pouch is a new and improved simple modification of the well-established J-pouch procedure, constructed using a single firing of a GIA stapler. J Korean Soc Coloproctol 2006;22:363-370