OBJECTIVE: We developed an experimental ex-vivo model to define factors that may influence continence of catheterizable channels by urinary and colonic stomas based on the principle of imbrication of the outlet tube. MATERIALS AND METHODS: From 20 pigs, colon specimens with 25 cm length were obtained and a transverse flap with 3.0 cm length x 1.5 cm width in the average point of the intestine was tubulated to create an efferent tube. With the tube configured, it was embedded by 3 seromuscular stitches far 0.5 cm each other. A pressure study of both intra-luminal surface and channel was then conducted during the filling of the submerse piece with environmental air in a water container, to define the efferent channel continence. The study was repeated after the progressive release of suture stitches until only one stitch remains. RESULTS: Channel continence analyzed in each segment in three different valve length situations, making a total of 20 segments, revealed that with 3 stitches (1.5 cm valve) the maximum average pressure prior to overflow was 54 cm H2O; 53.65 cm H2O with 2 stitches (1.0 cm of valve), and 55.45 cm H2O with only one stitch (0.5 cm of valve), which are the same values. The record at the segment explosion pressure was 67.87 cm H2O. CONCLUSION: The study showed that angulation of channel with colon, maintained by only one stitch (0.5 cm imbrication) was more important than a larger extension of the valve, represented by 3 suture stitches (1.5 cm imbrication) in order to allow continence to the efferent channel.

OBJETIVO: Avaliar uma técnica de reconstituição da válvula ileocecal com base em técnicas anti-refluxo vesicoureteral. MÉTODOS: Quatorze beagles foram operados. Em sete foi reconstituída a válvula ileocecal com a técnica proposta e nos outros sete realizou-se apenas a anastomose ileocólica término-terminal. Para avaliar a neoválvula realizou-se o acompanhamento clínico dos cães, a análise microbiológica e o estudo manométrico. RESULTADOS: Clinicamente, durante os 45 dias de pós-operatório, não houve diferença entre os cães com e sem reconstituição da válvula ileocecal. Na análise de bactérias aeróbias, a bactéria predominante foi a Escherichia coli. Quantitativamente, as culturas cresceram de modo irregular, não permitindo a comparação do crescimento bacteriano entre os grupos com e sem válvula ileocecal. A neoválvula apresentou uma pressão de refluxo ileocólica semelhante a da válvula ileocecal fisiológica (P>0,05). Em relação ao grupo sem válvula, as pressões de refluxo da válvula fisiológica e da neoválvula foram significantemente maiores, sendo P<0,05 e P<0,001, respectivamente. CONCLUSÃO: A neoválvula ileocecal serviu de obstáculo ao refluxo colo-ileal de maneira semelhante à válvula ileocecal fisiológica.

PURPOSE: The importance of keeping the ileocecal valve in the intestinal ressections has been reported by several authors. When preserved, the ileocecal valve was related to a longer survival and prevention of the short bowel syndrome, due to its ability to block the colonic content reflux into the ileum and to avoid the rapid empting of the ileal content into the cecum. It was assessed a tecnique of ileocecal valve reconstitution, based on vesicoureteral anti-reflux tecniques. METHODS: Fourteen beagles were operated. Seven underwent ileocecal valve reconstitution following the tecnique proposed and in the other seven a simple end-to-end anastomosis was performed. To assess the new valve, it was done the clinical follow up, the microbiologic analysis and the manometric study. RESULTS: Clinically, during 45 days of follow up, there was no difference between the dogs with and without ileocecal reconstitution. In the aerobic bacteria analysis, the predominant bacterium was Escherichia coli. Quantitatively, the cultures grew in an irregular way, so that it was not able to compare the bacterial growth between the groups with or without ileocecal valve. The new valve had a colo-ileal reflux pressure similar to that of the physiological valve (P>0.05). However, when compared to the non valve group, the reflux pressures of the physiological valve and new valve were significantly higher, with P<0.05 and P<0.001, respectively. CONCLUSION: In this study, the reconstituted ileocecal valve served as a barrier to the colo-ileal reflux just as the physiological valve does.

Racional — O choque hipovolêmico está incluído entre os fatores de risco para anastomoses intestinais, entretanto, sua ação sobre anastomoses do intestino delgado tem sido pouco estudada e, quando abordado, é avaliado como parâmetro de comparação com a cicatrização de cólons e não como alvo central das investigações. Objetivo - Estudar o efeito do choque hipovolêmico na anastomose do intestino delgado de ratos. Método - Foram utilizados 90 ratos machos adultos, distribuídos em cinco grupos: padrão, choque, anastomose, choque mais anastomose e choque mais anastomose mais reposição. O choque hipovolêmico foi obtido pela sangria de 30% da volemia do animal. Realizou-se anastomose término-terminal em plano único extra-mucoso, à média distância, entre o duodeno e a válvula ileocecal. A reposição volêmica no grupo choque, mais anastomose mais reposição foi realizada com o sangue autólogo. Resultados e Conclusão - Do ponto de vista histológico, o choque hipovolêmico provocou alterações progressivas na região da anastomose intestinal, quanto à lesão da túnica mucosa e o aumento na deposição de fibras colágenas na tela submucosa, com a evolução do período pós-operatório. Quanto à pressão de ruptura promoveu, em relação aos grupos controle, tendência a diminuição da resistência da parede intestinal e da anastomose intestinal com a evolução do período pós-operatório.

Objective — Study the effect of hypovolemic shock on small intestinal anastomose in adult rats. Method — Ninety male rats were randomly divided into five groups: standard, hypovolemic shock, anastomose alone, hypovolemic shock + anastomose and hypovolemic shock + anastomose + blood reinfusion. Hypovolemic shock was achieved by bleeding 30% of the blood volume of the animal. A single layer extramucosal intestinal anastomose was performed. Following intestinal anastomose, the blood volume was restored in group shock, anastomose and blood reinfusion, using heparinized autologous. Results and Conclusion — In the experimental model used, hypovolemic shock provoked histological lesions to the mucosa and increased colagen fiber deposition into the submucosa in the region of intestinal anastomose which were progressive with post-operative period. In addition, when the hypovolemic shock group were pressure tested there was a tendency towards a weakening of the intestinal wall at day 7 which became more evident at day 21 as compared to the control groups.