Effect of ileo-jejunal transposition on intestinal adaptation after total colectomy in dogs

The effect of ileo-jejunal transposition (IJT) on the intestinal adaptation after total colectomy was investigated in 4 mongrel dogs. Hyperenteroglucagonemia was observed in the IJT with colectomy group, especially in postprandial state. Obvious hyperplastic changes were observed in all part of the small intestinal mucosa in the colectomy with IJT group. However, there were no significant differences in body weight changes between the colectomy with IJT group and the colectomy group. Postprandial plasma gastrin levels were lower in the colectomy with IJT group compared to the control. These results suggest that IJT causes hyperenteroglucagonemia and intestinal mucosal hypertrophy in colectomized dogs. Enteroglucagon may have an inhibitory effect on postprandial gastrin release.

[The influence of ileo-jejunal transposition on intestinal mucosal growth and gut hormones after total colectomy]

To clarify the effect of ileo-jejunal transposition on intestinal mucosal height and gut hormones, canine models undergoing total colectomy either with transection of the small intestine (control group) or ileo-jejunal transposition (transposition group) were compared, and the following results were obtained. There was no difference in body weight between control group and transposition group 18 weeks after operation. Significant increase of mucosal height was observed in transposition group but not in control group. Plasma levels of total GLI were significantly higher in transposition group but not in control group, whereas a count of GLI secreting cell was not changed in both groups. Plasma levels of gastrin after test meal were lower in transposition group than in control group. These results indicated that ileo-jejunal transposition induces hyperenteroglucagonemia, which may play an important role in intestinal adaptation after colectomy.

[Surgical problems of Kock's continent ileostomy in patients with ulcerative colitis]

Postoperative problems including pathophysiology at follow up were investigated in Kock's continent ileostomy in patients with ulcerative colitis. The results obtained were as follows: Though postoperative complication was found in all 4 cases, it was improved in 3 of them by conservative or surgical treatment. Troublesome skin irritation, such as erosion or ulcer, was not found in any case. The patients empty the reservoir when it is convenient and intestinal discharge was 1 to 4 times per day and these results were proved from the studies of the pressure and capacity in the Kock's ileostomy. Various plasma amino acids in patients with Kock's ileostomy showed almost similar levels to those of the normal subjects. Bacteriological examination in the stool in Kock's ileostomy also revealed almost similar results to those of the normal subjects. From these results, we conclude that Kock's continent ileostomy should be more widely performed for the patients with ulcerative colitis when ileostomy is required.

Long term follow-up of surgical treatment for ulcerative colitis--with special reference to recurrence and the quality of life

From 1961 to 1984, fifty-one patients with ulcerative colitis were surgically treated at Tohoku University Hospital. The results of various types of surgical treatments for ulcerative colitis were analysed and discussed with special reference to recurrence and the quality of life at the time of follow-up. Total colitis and left-sided colitis were observed in 42 and 9 patients, respectively. There were five operative deaths. Thirteen patients received total proctocolectomy and 38 patients received various types of conservative operations at the first operation. In seven patients there was a recurrence of the disease in the retained colon or rectum and proctocolectomy with ileostomy was carried out. Forty-six patients were followed. Four died of other diseases and two were lost to follow-up. The periods of follow-up after the final operation ranged from 3-29 years. The types of operative procedures were ileostomy in 19, ascendicostomy in 14, ileoproctostomy in 6 and ascendicoproctostomy in 1 patient. Following treatment of recurrence of the disease, in most patients who had undergone various surgical treatments, favorable results of quality of life were attained, even in those with ileostomy. These results indicate that it is important to select the most proper types of operative procedures for surgical treatment of ulcerative colitis by individualizing each case.

[Surgical treatment of Crohn's disease]

Fourteen patients with Crohn's disease underwent operation at our department. Twelve were males and 2 were females, with a mean age of 28 years. The lesions were found in the small intestine in 5 patients, in the small and large intestines in 5 and in the large intestine in 4. The indications for laparotomy were stenosis in 43%, intractability in 43% and others in 14%. Stenosis was most commonly indicated in the small intestinal lesions, and intractability in the large intestinal lesions. For 12 patients, resection of the involved intestine was carried out, however for another 2, partial resection of the involved intestine was performed to avoid short bowel syndrome. Postoperative recurrence rate, in the cases where the involved intestine was totally resected, was 40% in the small intestinal lesions, 33% in the small and large intestinal lesions and 0% in the large intestinal lesions. Postoperative quality of life for most patients was excellent or good, and hematological status at follow-up showed an almost normal range. From these results, in patients with Crohn's disease, it was thought that the operation should be performed soon after medical treatment has failed.