Pouch Configuration

Although the initial reservoir described by Parks and Nicholls [5] was triple limbs of the ileum shaped in

"S" configuration, surgeon creativity produced several designs - "J", "H", "K" and "W"- to overcome the difficulties of evacuation connected with the exit conduit of the S-shaped pouch and improve its functionality [8, 24]. The J-shaped configuration was adopted by most surgeons [6, 21, 23, 24] because of ease of construction using staplers and efficient evacuation even if its lower initial compliance may give rise to an increase in the defecation frequency at least in the initial period after the ileostomy take down [7]. Regardless, 1 year after surgery, the J-shaped pouch increases its ability by 300-400%, allowing suitable stabilisation of daily evacuations [25]. A comparative study into features of three different-shaped ileal reservoirs (S, J, K) showed that even if the S- and K-shaped reservoirs reach higher volumes 1 year after surgery (410 ml vs 305 ml), as a matter of fact, functional results do not differ much [24]. The W-shaped pouch has probably a small advantage in comparison with the J-shaped pouch in terms of evacuation frequency, at least in the first period after ileostomy closure, but this difference disappears with time [10], and 1 year after surgery, the two reservoirs give the same results [10, 26]. The choice among the various configurations is more a matter of personal taste, and as far as suitable ileal tract is concerned (at least 30-cm long), functional behaviour can be compared [24].

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