Achieving stomal continence with an ileal pouch and a percutaneous implant

Martin L Johansson,Leif Hultén,Bjørn Edwin,Olof Jonsson,Peter Thomsen,Heithem Ben Amara

doi:10.1007/s10856-021-06633-4

Abstract

In this study, a soft-tissue-anchored, percutaneous port used as a mechanical continence-preserving valve in reservoir ileo- and urostomies was functionally and morphologically evaluated in eight dogs. During follow-up, the skin failed to attach to the implant, but the intestine inside the stoma port appeared to be attached to the mesh. After reaching adequate reservoir volume, the urostomies were rendered continent by attaching a lid to the implant. The experiments were ended at different time intervals due to implant-related adverse events. In only one case did the histological evaluation reveal integration at both the implant-intestine and implant-skin interfaces, with a low degree of inflammation and the absence of bacterial colonisation. In the remaining cases, integration was not obtained and instead mucosal downgrowth and biofilm formation were observed. The skin-implant junction was characterised by the absence of direct contact between the epidermis and the implant. Varying degrees of epidermal downgrowth, granulation tissue formation, inflammatory cell infiltration and bacterial growth and biofilm formation were prominent findings. In contrast, the subcutaneously located anchor part of the titanium port was well integrated and encapsulated by fibrous tissue. These results demonstrate the opportunity to achieve integration between a soft-tissue-anchored titanium port, skin and intestine. However, predictable long-term function could not be achieved in these animal models due to implant- and non-implant-related adverse events. Unless barriers at both the implant-skin and implant-intestine junctions are created, epidermal and mucosal downward migration and biofilm formation will jeopardise implant performance.

Highlights

Inflammatory bowel disease, colorectal and gynaecological cancer, neurological bladder disorders and bladder cancer sometimes require excisional surgery with the creation of an abdominal stoma
Many attempts have been made over the years to overcome the problems of a conventional stoma by creating continent ileo- or urostomies, complex constructions often associated with considerable morbidity and failure rates [1,2,3,4,5]
The continent ileostomy, first described by Dr Nils Kock in 1969, gained popularity in the 1970s and early 1980s, and the technique was used for urinary diversion [6,7,8]

Summary

Introduction

Inflammatory bowel disease, colorectal and gynaecological cancer, neurological bladder disorders and bladder cancer sometimes require excisional surgery with the creation of an abdominal stoma. Many attempts have been made over the years to overcome the problems of a conventional stoma by creating continent ileo- or urostomies, complex constructions often associated with considerable morbidity and failure rates [1,2,3,4,5]. The continent ileostomy, first described by Dr Nils Kock in 1969, gained popularity in the 1970s and early 1980s, and the technique was used for urinary diversion [6,7,8]. This method offers good continence in most cases, and patients enjoy a good quality of life. A number of methods to stabilise the nipple valve have been tried over the years, but the problem has not yet been satisfactorily solved, and the nipple valve is still the Achilles’ heel of both constructions [9,10,11]

Methods

Results

Discussion

Conclusion