Modified ileal conduit stoma: safety of freeing the mesenteric edge of the distal part of ileal conduits. 2007

Mohamed M Abdallah, and Nabil K Bissada
Faculty of Medicine, Menoufia University, Menoufia, Egypt, and University of Arkansas for Medical Sciences, Little Rock, Arkansas 72205, USA.

OBJECTIVE An ileal conduit is created in about half of all urinary diversions. Difficulties in constructing an abdominal stoma in morbidly obese patients can be challenging, especially if the patient has a short mesentery. Excessive traction on the mesentery in an attempt to pass the distal segment of ileum through the thick abdominal wall may result in ischemia of the whole segment blood supply. We evaluated the safety of freeing the terminal portion of the conduit from its mesentery to facilitate easy passage of the conduit through the abdominal wall and decrease the incidence of parastomal hernia. METHODS Five domestic pigs were used for this study. In each subject a 10 cm segment of ileum was isolated to form the ileal loop and bowel continuity was established. A 3 to 4 cm segment of the distal ileal loop was freed from its mesenteric blood supply. This segment of the loop was passed through the appropriate defect in the abdominal wall to the skin and an everted stoma was constructed. Postoperatively the animals were followed for 1 month and then sacrificed. The ileal loop with its mesentery and surrounding skin were harvested en bloc and sent for gross and histological examination. RESULTS Mean postoperative time was 30 days (range 29 to 32). No mortality or perioperative complications were recorded. All animals had an uneventful postoperative course until the scheduled time for specimen collection. At harvesting the stoma remained pink in all animals. Gross examination and calibration demonstrated no evidence of narrowing or stenosis. Histological examination revealed no ischemic changes. The mucosa of the entire ileal loop was uniform and healthy. CONCLUSIONS Freeing the mesenteric edge of the ileal loop is safe. This finding has an important application for allowing easy construction of an ileal loop or continent cutaneous diversion stoma in morbidly obese patients. This finding is also applicable when constructing terminal ileostomy or colostomy stoma in select patients.

UI MeSH Term Description Entries
D007081 Ileostomy Surgical creation of an external opening into the ILEUM for fecal diversion or drainage. This replacement for the RECTUM is usually created in patients with severe INFLAMMATORY BOWEL DISEASES. Loop (continent) or tube (incontinent) procedures are most often employed. Loop Ileostomy,Tube Ileostomy,Continent Ileostomy,Incontinent Ileostomy,Continent Ileostomies,Ileostomies,Ileostomies, Continent,Ileostomies, Incontinent,Ileostomies, Loop,Ileostomies, Tube,Ileostomy, Continent,Ileostomy, Incontinent,Ileostomy, Loop,Ileostomy, Tube,Incontinent Ileostomies,Loop Ileostomies,Tube Ileostomies
D007082 Ileum The distal and narrowest portion of the SMALL INTESTINE, between the JEJUNUM and the ILEOCECAL VALVE of the LARGE INTESTINE.
D008643 Mesentery A layer of the peritoneum which attaches the abdominal viscera to the ABDOMINAL WALL and conveys their blood vessels and nerves. Mesenteries
D009767 Obesity, Morbid The condition of weighing two, three, or more times the ideal weight, so called because it is associated with many serious and life-threatening disorders. In the BODY MASS INDEX, morbid obesity is defined as having a BMI greater than 40.0 kg/m2. Morbid Obesity,Obesity, Severe,Morbid Obesities,Obesities, Morbid,Obesities, Severe,Severe Obesities,Severe Obesity
D000818 Animals Unicellular or multicellular, heterotrophic organisms, that have sensation and the power of voluntary movement. Under the older five kingdom paradigm, Animalia was one of the kingdoms. Under the modern three domain model, Animalia represents one of the many groups in the domain EUKARYOTA. Animal,Metazoa,Animalia
D014547 Urinary Diversion Temporary or permanent diversion of the flow of urine through the ureter away from the URINARY BLADDER in the presence of a bladder disease or after cystectomy. There is a variety of techniques: direct anastomosis of ureter and bowel, cutaneous ureterostomy, ileal, jejunal or colon conduit, ureterosigmoidostomy, etc. (From Campbell's Urology, 6th ed, p2654) Ileal Conduit,Conduit, Ileal,Conduits, Ileal,Diversion, Urinary,Diversions, Urinary,Ileal Conduits,Urinary Diversions
D034421 Sus scrofa A species of SWINE, in the family Suidae, comprising a number of subspecies including the domestic pig Sus scrofa domestica. Pig, Domestic,Sus scrofa domesticus,Wild Boar,Sus scrofa domestica,Boar, Wild,Boars, Wild,Domestic Pig,Domestic Pigs,Pigs, Domestic,Wild Boars

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