Ileorectal Anastomoses Research Articles

Postoperative nonsteroidal anti-inflammatory drugs in relation to recurrence, survival and anastomotic leakage after surgery for colorectal cancer.

AimThe aim of this work was to investigate whether nonsteroidal anti‐inflammatory drugs (NSAIDs) could be beneficial or harmful when used perioperatively for colorectal cancer patients, as inflammation may affect occult disease and anastomotic healing.MethodThis is a protocol‐based retrospective cohort study on colorectal cancer patients operated on between 2007 and 2012 at 21 hospitals in Sweden. NSAID exposure was retrieved from postoperative analgesia protocols, while outcomes and patient data were retrieved from the Swedish Colorectal Cancer Registry. Older or severely comorbid patients, as well as those with disseminated or nonradically operated tumours were excluded. Multivariable regression with adjustment for confounders was performed, estimating hazard ratios (HRs) for long‐term outcomes and odds ratios (ORs) for short‐term outcomes, including 95% confidence intervals (CIs).ResultsSome 6945 patients remained after exclusion, of whom 3996 were treated at hospitals where a NSAID protocol was in place. No association was seen between NSAIDs and recurrence‐free survival (HR 0.97, 95% CI 0.87–1.09). However, a reduction in cancer recurrence was detected (HR 0.83, 95% CI 0.72–0.95), which remained significant when stratifying into locoregional (HR 0.68, 95% CI 0.48–0.97) and distant recurrences (HR 0.85, 95% CI 0.74–0.98). Anastomotic leakage was less frequent (HR 0.69%, 95% CI 0.51–0.94) in the NSAID‐exposed, mainly due to a risk reduction in colo‐rectal and ileo‐rectal anastomoses (HR 0.47, 95% CI 0.33–0.68).ConclusionThere was no association between NSAID exposure and recurrence‐free survival, but an association with reduced cancer recurrence and the rate of anastomotic leakage was detected, which may depend on tumour site and anastomotic location.

ENDOSCOPIC STRICTUROTOMY – A NOVEL THERAPEUTIC MODALITY FOR IBD-RELATED STRICTURES: FIRST EUROPEAN EXPERIENCE

Abstract INTRODUCTION Both primary strictures and secondary anastomotic strictures are common complications in patients with inflammatory bowel diseases (IBD), especially Crohn’s disease (CD). Balloon dilation has been the gold standard in the endoscopic treatment of these strictures. Endoscopic stricturotomy (ESt, Figure 1) represents a promising novel approach, however, the data published on this method so far has been limited to a small sample and few sites. METHODS All ESts performed in IBD patients between September 2018 and April 2021 in our tertiary IBD center were included. Data on demographics, disease characteristics, procedure details and outcomes were analyzed. Technical success was defined as an ability to pass the scope through the stricture following the procedure. Complications included perforation and immediate or delayed bleeding with the need of intervention or hospitalization. RESULTS In total, 92 procedures were performed in 67 patients (60 with Crohn’s disease, CD, and 7 with ulcerative colitis, UC) Among these 46.3% were males. Mean age was 43.9±12.5 years and mean disease duration was 14.6±9.7 years. Single ESt was done in 73.1% (49) of patients, while 26.9% (18) required multiple procedures. Most common location of stricture was surgical anastomosis site (82, 89.1%), while remaining 10 were located at anal canal (de novo stricture). Anastomotic strictures included ileo-colonic (64.1%), colo-colonic (9.8%), ileo-rectal (3.3%), and ileal pouch-anal (12.0%) anastomoses. Previous endoscopic balloon dilation (EBD) was attempted in 53.3% of the procedures, 27.2% of the analyzed procedures were preceded by earlier ESt. Technical success was achieved in 83 ESts (90.2%), complications occurred in four cases (all delayed bleeding, managed conservatively). After the mean follow-up time of 18.1±10.0 months, cumulative probability of reintervention (ESt, EBD or surgery) at 6 months was 30.2% (95% CI 15.6-46.2%), 40.3% (95% CI 25.5-54.6%) at 12 months and 48.8% (95% CI 34,0-62,1%) at 18 months (Figure 2). Time to reintervention was not significantly affected by previous intervention, age of the anastomosis, sex or age of the patients, concurrent therapy and specific ESt technique employed. CONCLUSION ESt is a novel endoscopic technique, which is both efficacious and safe to be performed in patients with IBD-related strictures.

A Near-Zero Anastomotic Leak Rate in Cytoreductive Surgery with Heated Intraperitoneal Chemotherapy is Achievable.

Gastrointestinal complications are the main source of severe morbidity after cytoreductive surgery (CRS) and heated intraperitoneal chemotherapy (HIPEC), mainly in the form of anastomotic leak. Reducing the rate of anastomotic leaks is of paramount importance and should be approached both through risk factor understanding and reduction, as well as optimization of surgical team performance. We performed a study that describes the details of a technical protocol for the creation of anastomoses after colorectal resections in CRS and HIPEC and the anastomotic outcomes associated with its systematic application in a high-volume peritoneal surface malignancy center. An extremely low, near-zero anastomotic leak rate (0.85% in colorectal anastomoses, 1% in ileo-colic anastomoses, and 0% in ileo-rectal anastomoses) was observed among 1172 patients. Extremely low, near-zero rates of anastomotic leak after colorectal resections in CRS and HIPEC could be achievable in high-volume peritoneal malignancy centers. The described techniques could be adopted and validated in other high-volume peritoneal malignancy centers.

Su1030 ENDOSCOPIC STRICTUROTOMY – A NOVEL THERAPEUTIC MODALITY FOR IBD-RELATED STRICTURES: FIRST EUROPEAN EXPERIENCE

Strictures, both primary and secondary anastomotic strictures, are common complications in patients with inflammatory bowel diseases (IBD) especially Crohn's disease (CD). Balloon dilation has been the gold standard in the endoscopic treatment of these strictures. Endoscopic stricturotomy (ESt) represent a promising novel approach, however, the data published on this method so far is limited to a single US center. All ESts performed in IBD patients between September 2018 and November 2019 in our tertiary IBD center were included. Data on demographics, disease characteristics, procedure details and outcomes were analyzed. Technical success was defined as an ability to pass the scope through the stricture following the procedure. In total, 46 procedures were performed in 39 patients (34 with Crohn's disease, CD, and 5 with ulcerative colitis, UC) Among these 38.5% were males. Mean age was 43.5±10.9 years and mean disease duration was 17.4±9.9 years. Single ESt was done in 82.1% of patients, while 17.9% required multiple procedures. Most common location of stricture was surgical anastomosis site (43, 93.5%), while remaining 3 were located at anal canal. Anastomotic strictures included ileo-colonic (71.7%), ileo-rectal (4.3%), and ileal pouch-anal (17.4%) anastomoses. Previous endoscopic balloon dilation (EBD) was attempted in 78.3% cases. Technical success was achieved in 42 ESts (91.3%), complications occurred in two cases (both delayed bleeding, managed conservatively). After the mean follow-up time of 8.2±4.3 months, cumulative probability of reintervention (ESt, EBD or surgery) at 6 months was 16.1% (95% CI 1.7-44.2%). ESt is a novel endoscopic technique, which is both highly efficacious and safe to be performed in patients with IBD-related strictures.

Four different ileorectal anastomotic configurations following total colectomy.

Ileorectal and ileosigmoid anastomoses are typically performed following total colectomy and subtotal colectomy, respectively. The current literature provides extensive description of more common anastomoses such as after right hemicolectomy or anterior resection. However, there is little focus in the literature on the ileorectal or ileosigmoid anastomotic technique, despite these anastomoses having a relatively high complication rate. The purpose of the current study is to describe four standardized ileorectal or ileosigmoid anastomotic configurations, with commentary on specific challenges and theoretical advantages and disadvantages of each.

Laparoscopic subtotal colectomy with double-end ileosigmoidostomy in right iliac fossa facilitates second-stage surgery in patients with inflammatory bowel disease.

There is no consensus about the most appropriate management of rectal stump in laparoscopic subtotal colectomy (STC) performed for inflammatory bowel disease (IBD). The objective is to report our experience of laparoscopic STC with double-end ileosigmoidostomy in the right iliac fossa for IBD. All patients undergoing laparoscopic STC and double-end ileosigmoidostomy in the right iliac fossa for IBD in 2 European expert centres were included. From 1999 to 2017, laparoscopic STC and double-end ileosigmoidostomy in right iliac fossa was performed in 213 consecutive patients, including 74 patients in an emergency setting (35%). Conversion to laparotomy was necessary in 9 patients (4%). One patient died postoperatively (0.5%). Postoperative morbidity occurred in 53 patients (25%) after STC, and was major in 18 patients (8%). A second stage was performed in 199 patients (94%), with a mean delay of 4.7 ± 6months (range 1.4-77). The second stage was an ileorectal anastomosis (n = 50/199; 25%), performed by an elective open incision in the right iliac fossa in 68% of cases; an ileal pouch-anal anastomosis (IPAA) (n = 139; 70%) successfully performed by laparoscopy in 96% of cases; or an abdominoperineal excision with end ileostomy (n = 10; 5%) successfully performed by laparoscopy in 8 cases. After this second stage, postoperative morbidity occurred in 53 patients (27%), and was major in 15 patients (8%). After a mean follow-up of 3.7 ± 3years (range 0.1-15), stoma rate (end ileostomy and diverting stoma not closed) was 17%, and small bowel obstruction and incisional hernia occurred in 10 (5%) and 25 (12%) patients, respectively. Laparoscopic STC and double-end ileosigmoidostomy in right iliac fossa is safe, feasible, and facilitates the second stage for intestinal continuity by either elective incision or laparoscopy in 100% of ileorectal anastomoses and by laparoscopy in 96% of IPAA.

Laparoscopic Subtotal Colectomy for Acute or Severe Colitis With Double-end Ileo-sigmoidostomy in Right Iliac Fossa

The aim of this study was to report an original technique of laparoscopic subtotal colectomy (STC) for acute colitis complicating inflammatory bowel disease where both ileostomy and sigmoidostomy are located in the right iliac fossa. Thirty-five consecutive laparoscopic STC cases with ileo-sigmoidostomy in right iliac fossa were retrospectively reviewed. There was no mortality. No patient was reoperated until stoma closure. Bowel continuity was restored by either ileorectal anastomosis (n=14) or secondary proctectomy with ileal-pouch-anal anastomosis (IPAA; n=21). Elective approach was performed in 11 of 14 ileorectal anastomoses (79%) and through iterative laparoscopy in 21 of 21 IPAA (100%). Laparoscopic STC with ileo-sigmoidostomy in right iliac fossa avoid a secondary wound incision for sigmoidostomy, and offers the possibility of an elective approach for ileorectal anastomosis as in 79% of the patients. It allowed, in all cases, a totally laparoscopic approach for the second step of IPAA.

Laparoscopic-Assisted Rectosigmoidectomy with Ileal Loop Interposition. Surgical Treatment of Chagasic Megacolon

Chagas disease is a frequent cause of acquired megacolon in several countries of Latin America. Several procedures have been described to treat this condition. Recently a report of 147 patients treated with an open rectosigmoidectomy with an ileal loop interposition showed a low rate of complications (8.5 percent) and recurrence (3.1 percent).1 We present the video of a 42-year-old Latin American man who had a diagnosis of chagasic megacolon and was treated with the technique described by Netinho et al. 1 but with the use of laparoscopy. The patient was placed in a supine modified lithotomy position in Allen stirrups; the monitor was placed near the left leg of the patient, and both the surgeon and the assistant stood at the right side of the patient. Four trocars were used. Exploratory laparoscopy was performed. The proximal third of the rectum, sigmoid, and left colon were fully mobilized. Vascular pedicles were sectioned. The rectum was divided by using a linear laparoscopic cutter. A Pfannensteil incision was made and the colon was proximally divided. An ileal loop was interposed isoperistaltically between the descending colon and the rectum. Both the ileoileal and the ileocolic anastomoses were handsewn, and the distal ileorectal anastomoses were performed with a circular stapler under laparoscopic control. The patient is without symptoms or recurrence one year after the surgery. Laparoscopic approach allows the easy and correct dissection of the lateral attachments and offers the advantages of a more cosmetic and less painful procedure. Laparoscopic rectosigmoidectomy with ileal loop interposition is a technique that can be performed by laparoscopy with good results and should be an option in the treatment of chagasic megacolon.

Linear Stapler Formation of Ileo-Rectal, Entero-Enteral and Gastrojejunal Anastomoses During Dual and Single Access “Pure” NOTES Procedures: Methods, Magnets and Stapler Modifications

Background: The development of rapid methods for forming anastomoses during NOTES procedures would be valuable but current linear staplers are poorly configured for these approaches. Aim: to use modified linear staplers to perform NOTES anastomoses. Methods: Anastomotic NOTES procedures were performed in 7 pigs (28-40 kg). Staplers were modified to allow guide-wire insertion or with an elongated shaft for suitable reach. New articulating rigid and flexible graspers were used for tissue manipulation.

Comparison of ileal apparent, standardized and true digestibilities of amino acids in pigs fed wheat and lupine seeds

The aims of the investigation were to compare calculation methods for ileal apparent digestibility (AD) of amino acids (AA) and to demonstrate the calculation of ileal true digestibility (TD) using the regression approach and additionally, to compare the TD with the standardized digestibility (SD). Eight Goettingen minipigs, average 52 kg initial BW, were fitted with ileo-rectal anastomoses and fed consecutively with assay diets in four experiments according to a Latin rectangle design. To determine AD by using the ‘direct method’, diets contained wheat, lupine, or casein as the sole sources of protein. Furthermore, the ‘difference method’ was used by applying diets with wheat plus casein or wheat plus lupine. To determine AD using the regression (‘Reg2’) method, three graded levels of lupine mixed with wheat were fed. The TD and the basal ileal endogenous losses of AA (EL bAA) were determined using the regression approach (‘Reg1’) by feeding both 5 graded levels of lupine and 5 graded levels of wheat, each added with N-free mixture at 1000 g. In each experiment, one repetition comprised 10 days for adaptation and 4 days for quantitative collection of ileal effluents. Pigs were fed twice a day and the target dietary allowance was 35 g DM kg − 0.75 BW d − 1 in all experiments. There were no differences in the AD of any AA in lupine or in wheat when those were determined with the direct, difference or Reg2 method. The TD values of the most indispensable AA were higher than the AD (in lupine 8 to 20%-units for lysine and methionine and in wheat 6 to 11%-units for tryptophan and lysine, respectively). These differences reflected the EL bAA derived from the intercept ( a) of the Reg1. The EL bAA were higher in lupine than in wheat for arginine, histidine, leucine, methionine, phenylalanine, tryptophan, cysteine, glutamine, and serine ( P < 0.007 to 0.047). In conclusion, the TD of AA should be determined by Reg1 regression rather than calculation of SD, i.e. AD values corrected with means of EL bAA, because the latter cannot be assumed as constant.

Impact of wheat grinding and pelleting in a wheat–rapeseed meal diet on amino acid ileal digestibility and endogenous losses in pigs

The purpose of the current experiment was to investigate the impacts of grinding and pelleting procedures applied to wheat in a wheat–rapeseed meal diet on the coefficients of standardized ileal digestibility, i.e., apparent digestibility corrected for basal endogenous losses (CSID), and true ileal digestibility, i.e., apparent digestibility corrected for total endogenous losses (CTID), of nitrogen (N) and amino acids (AA) in pigs. Ileal digestibility was measured by collecting digesta from pigs fitted with ileorectal anastomoses. Four diets, involving four technological treatments applied to wheat, were compared in vivo according to a 4 × 4 Latin square design (four pigs each fed four diets during four successive periods of 1 week). The technological treatments of wheat were two grinding procedures and two pelleting processes. Wheat was ground to obtain mean flour particle sizes of 1000 and 500 μm, leading after mixing with rapeseed meal and minerals-vitamins premix to the first and second diets named “coarse” and “fine”, respectively. Part of the 500 μm wheat flour was pelleted through dies of same screen diameter (4 mm) but different thicknesses, 16 and 20 mm, inducing a low and high compression ratio, leading after mixing with rapeseed meal and premix to the third and fourth diets named “LCR” and “HCR”, respectively. Basal endogenous losses were determined by feeding a protein-free diet during the 5th week of the experiment. Total endogenous losses were measured by way of the isotopic dilution method using 15N-labeled wheat and rapeseed meal. Decreasing wheat particle size from 1000 to 500 μm improved (P<0.05) the coefficient of ileal digestibility of dietary energy (0.707 versus 0.665), organic matter (0.718 versus 0.677) and dry matter (0.681 versus 0.645), but neither AA CSID nor N retention. The pelleting processes did not further increase (P>0.10) energy or organic matter digestibility but improved (P<0.05) N and AA CSID (0.785 versus 0.759 for N and 0.725 versus 0.679 for lysine, with HCR versus fine diet, respectively). Pelleting wheat flour at higher compression ratio (HCR versus LCR diet) was more efficient to improve dietary N and AA digestibility values due to a significant decrease in ileal specific, i.e., total minus basal, N and AA endogenous losses (P<0.05) associated with an increase in CTID. It is concluded that pelleting wheat fine flour at high compression ratio allows maximizing AA digestibility and availability of a wheat–rapeseed meal diet.

Meta-analysis of observational studies of ileorectal versus ileal pouch–anal anastomosis for familial adenomatous polyposis

Surgery for familial adenomatous polyposis (FAP) aims to minimize cancer risk while providing good functional outcome. Colectomy with ileorectal anastomosis and proctocolectomy with ileal pouch-anal anastomosis both offer this, but there is no clear consensus about which is better. This is a meta-analysis of comparative studies published between 1991 and 2003 reporting early and late postoperative adverse events, functional outcomes and quality of life. Twelve studies containing 1002 patients (53.4 per cent ileal pouch, 46.6 per cent ileorectal anastomosis) were identified. Bowel frequency (weighted mean difference 1.62 (95 per cent confidence interval (c.i.) 1.05 to 2.20)), night defaecation (odds ratio (OR) 6.64 (95 per cent c.i. 2.99 to 14.74)) and use of incontinence pads (OR 2.72 (95 per cent c.i. 1.02 to 7.23)) were significantly less in the ileorectal group, although faecal urgency was reduced with the ileal pouch (odds ratio 0.43 (95 per cent c.i. 0.23 to 0.80)). Reoperation within 30 days was more common after ileal pouch construction (23.4 versus 11.6 per cent; OR 2.11 (95 per cent c.i. 1.21 to 3.70)). There was no significant difference between the techniques in terms of sexual dysfunction, dietary restriction, or postoperative complications. Rectal cancer was a diagnosis only in the ileorectal group (5.5 per cent). Ileal pouch and ileorectal anastomoses have individual merits. Further research is needed to determine which most benefits patients with FAP.

Perineal excision of the rectum.

An intersphincteric and perimuscular approach was employed for perineal excision of the rectum in 33 patients who had previously undergone total colectomy with preservation of the rectum. Laparotomy was avoided in 28 of the 29 patients who had had closure of the rectal stump with ileostomy. Of the four patients (two with ileorectal anastomoses and two with sigmoid mucous fistulas) for whom laparotomy was planned, this was considered to be much less extensive than would otherwise have been required. It is concluded that in patients who have previously undergone total colectomy for inflammatory bowel disease, subsequent perineal excision of the rectal stump without laparotomy is frequently possible.

Aetiology and surgical management of toxic megacolon

The purpose of this article is to review the surgical management and outcome of toxic megacolon and to update the aetiology of toxic megacolon. A retrospective chart review of three academic colorectal surgery units was undertaken. Over a period of 20 years, 70 patients with surgically managed toxic megacolon were identified: 32 men and 38 women, median age 63 years (range, 23-87 years). In 33 (48%) patients the main cause of toxic megacolon was inflammatory bowel disease. Thirty-seven (52%) patients had toxic megacolon of different aetiology. Sixty-three patients underwent colonic resection: 49 (70%) subtotal colectomies and 14 (20%) total colectomies, including 4 (6%) proctocolectomies. Seven (10%) patients had decompression (n=3) or faecal diversion (n=4) only. Forty-four of the resected patients underwent a Hartmann's procedure and an ileostomy; 13 (19%) patients had primary anastomoses, 11 (16%) ileorectal anastomoses (IRA) and 2 (3%) patients had ileal pouch-anal anastomosis (IPAA). Twenty-six (37%) patients subsequently had continuity restored. Total surgical complication rate was 19% (n=13), 8% (n=4) in patients treated with subtotal colectomy, 21% (n=3) in patients treated with total proctocolectomy and 86% (n=6) in patients treated with either decompression or diversion. The total mortality rate was 16% (n=11). Toxic colitis complicated by toxic megacolon can occur after various diseases of the colon and remains a life-threatening disorder associated with a significant risk of postoperative complications. Subtotal colectomy with ileostomy remains the procedure of choice. Surgical colonic decompression with faecal diversion alone is associated with a high rate of complications.

Cholesterol-lowering effects of dietary blue lupin (Lupinus angustifolius L.) in intact and ileorectal anastomosed pigs

The present study was undertaken to investigate the effect of cholesterol-enriched casein (CAS) and blue lupin seed (BL) diets on the cholesterol metabolism of intact (INT) and ileorectal anastomosed (IRA) pigs. For 3 weeks, four groups of six pigs were allocated to the treatments (CAS-INT, CAS-IRA, BL-INT, and BL-IRA). Diet-induced hypercholesterolemia was inhibited by the BL through a substantial decrease in plasma LDL-cholesterol. The BL also reduced liver esterified and total cholesterol, increased hepatic LDL receptor synthesis and HMG-CoA reductase activity, and stimulated intestinal bile acid reabsorption. The neutral sterol output was higher in BL- than in CAS-fed pigs. The bile acid output was lower in IRA than in INT pigs. Surgery also prevented steroid microbial transformation, but it did not influence plasma cholesterol levels. These results suggest that the hypocholesterolemic effect of the BL, compared with the CAS, is attributable to impaired intestinal cholesterol absorption, probably involving increased bile acid reabsorption and higher contents of dietary phytosterols, both factors that reduce the micellar solubilization of cholesterol. Furthermore, according to our data, the contribution of the large intestine to cholesterol metabolism is very weak.

Fate of the Rectum after Colectomy with Ileorectal Anastomosis in Ulcerative Colitis

Aim of the study was to evaluate the cumulative success of colectomy and ileorectal anastomosis in 20 patients with ulcerative colitis. Data were collected from patient histories and cumulative success was calculated by the Kaplan-Meier method. Seven of 20 (35%) ileorectal anastomoses were lost. Cumulative success rate was 84% at 5 years, 69% at 10 years and 56% at 20 years. Most common indication for proctectomy was disabling proctitis. Other reasons for failure were postoperative ileal necrosis and persisting presacral infection. Patients with advanced colonic cancer managed relatively well with ileorectal anastomosis until death. No cases of rectal cancer were detected during postoperative follow-up but one moderate dysplasia was treated locally. Ileorectal anastomosis can be chosen for patients who are not suitable for ileoanal operation. Rectal endoscopies are mandatory postoperatively.

Technological processes of feed manufacturing affect protein endogenous losses and amino acid availability for body protein deposition in pigs

In the pig, dietary protein value depends on the availability of amino acids (AA), usually estimated by way of ileal digestibility measurement. However, AA availability for body protein deposition is influenced by endogenous digestive losses specifically induced by feed components. The purpose of the experiment was to assess the impact of some feed manufacturing processes on AA ileal endogenous losses and their resulting availability for growth. Four technological treatments were applied to a wheat–sunflower meal mix and compared in vivo according to a 4×4 Latin square design. These treatments were two grinding conditions, leading to different particle sizes (1000 and 500 μm), and two pelleting processes, “regular” and “high-flow extrusion” (HFE), operated on the finest particle size only. Ileal specific endogenous losses and the coefficient of ileal real digestibility (CIRD) of AA were measured by way of the isotopic dilution method using 15 N -leucine labelled pigs fitted with ileorectal anastomoses. The impact on nitrogen (N) and AA availability was assessed by N balance. Decreasing particle size from 1000 to 500 μm improved ( P<0.05) N (0.849 vs. 0.888) and AA (0.849 vs. 0.890 for valine) CIRD, as well as the ileal energy digestibility. In contrast to the regular pelleting process, the HFE process increased ( P<0.05) energy digestibility and improved ( P<0.05) N (0.792 and 0.824 for fine mash and HFE pelleting, respectively) and AA (0.795 vs. 0.840 for valine) coefficient of standardised digestibility (CISD). This effect of HFE was due to a significant decrease in N and AA endogenous losses ( P<0.05) rather than to a reduction in dietary protein ileal flow. However, due to the metabolic costs associated with the production of endogenous proteins, CISD variation could not accurately reflect the quantitative change in AA availability associated with the HFE process. On the basis of N balance data, we could estimate these costs and defined coefficients of ileal standardised availability of N (CISA) for body protein deposition. The improvements in N CISD and N CISA due to the HFE process were 4.0 and 12.6%, respectively.

Effects of body weight and feed intake level on basal ileal endogenous losses in growing pigs.

An experiment was carried out to determine the effects of feeding level, body weight, and time after surgery on basal ileal endogenous amino acid (AA) and N losses in growing pigs. Three pairs of littermate pigs were surgically prepared with ileo-rectal anastomoses. One pig in each pair was anastomosed at 38 kg BW, and the remaining pigs were anastomosed at 67 kg BW. Each pig received at different periods 50, 70, or 90 g of dry matter per kilogram of BW.75 of a protein-free diet according to a Latin square design involving three pigs starting at 45 kg BW and involving six pigs starting at 77 kg BW. For most AA, the time after surgery x feeding level interaction was significant. The basal endogenous losses (in g/d) increased linearly with feeding level at both BW. At the higher BW, the basal endogenous losses (in g/kg DMI) were constant regardless of feeding level, whereas at the lower BW they responded quadratically. At the low feeding level, the endogenous losses were higher than at the medium or high feeding level. We concluded that the basal endogenous losses are proportional to DMI when the feeding level is higher than 70 g/kg BW.75. The AA profile was not influenced by these three variables, but there was a large animal effect. These results suggest that, in digestibility trials, an assessment of the basal ileal endogenous AA losses must be performed on each pig to correct the apparent ileal AA digestibility data.

The 15N Amino Acid Dilution Method Allows the Determination of the Real Digestibility and of the Ileal Endogenous Losses of the Respective Amino Acid in Pigs

We assessed the influence of sampling site when using the isotope dilution method to determine ileal endogenous N losses. Three growing pigs were prepared with ileorectal anastomoses and fitted with three catheters (portal, jugular and carotid). A 15N-leucine solution was infused for 24 d, alternating between the carotid artery and the jugular vein. Blood was sampled from the portal catheter and from the systemic catheter not used for the infusion. The pigs were fed successively a protein-free diet, an isolated pea protein diet and a hydrolyzed pea protein diet according to a Latin-square design. The 15N was transferred from leucine to isoleucine, valine, alanine, glycine and proline. Free 15N alanine, glycine and valine enrichments were closer to the respective amino acid enrichments in secretory tissues in the portal vein than in the systemic blood. The enrichment of total nitrogen was higher in the trichloroacetic acid–soluble fraction of the plasma than in the ileal digesta of pigs fed the protein-free diet. Lysine enrichment was significantly different from zero in all tissues except muscle, suggesting that essential amino acids can be synthesized by microflora and used for protein synthesis in the host. We conclude that the total nitrogen isotope dilution method is inappropriate to determine the endogenous loss of amino acids. Moreover, the amino acid dilution method should be performed with portal blood sampling. The main limititation of this method is that a number of essential amino acid losses cannot be determined.

Short-chain fatty acids, lactate, and ammonia in ileorectal and ileal pouch contents: a model of cecal fermentation.

Fecal concentrations of total short-chain fatty acids were normal in 16 patients with ileorectal anastomoses (mean +/- SEM, 99.7 +/- 10.3 mmol/L) and 28 patients with ileal pouch-anal anastomoses (138.8 +/- 8.5 mmol/L) and did not differ from those in 14 healthy noncolectomized controls (130.7 +/- 12.6 mmol/L). Acetate:propionate:butyrate:isobutyrate+valerate+isovalerate ratios were similar in the ileorectum (71:12:12:5%) and in the colorectum (66:14:13:7%) of healthy noncolectomized controls, whereas the concentration of acetate was increased at the expense of the polypeptide-derived isobutyrate, valerate, and isovalerate in the ileal pouch (77:12:11:1%). Ammonia was accordingly significantly diminished in ileal pouch contents (28.8 +/- 3.2 mmol/L vs 45.2 +/- 4.1 mmol/L in controls) in contrast to concentrations in ileorectal contents (36.2 +/- 5.3 mmol/L). Concentrations of lactate were normal and low. Twenty-four-hour productions of total short-chain fatty acids in 16.6% fecal homogenates from both groups of patients were normal. Addition of saccharides (eg, glucose, starch, pectin, ispaghula husk) increased the production of acetate, propionate, and butyrate and decreased the production of ammonia and isobutyrate, valerate, and isovalerate, which was increased in homogenates with albumin added. This pattern of substrate fermentation was similar in homogenates from ileal pouch, ileorectum, and control colorectum. In conclusion, the concentrations of short-chain fatty acids, lactate, and ammonia indicate that ileorectal fermentation resembles normal colorectal fermentation in noncolectomized healthy individuals, whereas the fermentation in ileal pouch contents seems to be more carbohydrate predominated.(ABSTRACT TRUNCATED AT 250 WORDS)