Two New Shapes of Continent Gastric Pouch (Choomsai Gastric Pouch) and a New Technique of a Continent Catheterizable Tube

Abstract

Objectives: To evaluate the shape, function, catheterization feasibility and complication of two shapes
of continent gastric pouch (Choomsai Gastric Pouch 1 & 2).
Patients and Methods: Data of 24 female patients (mean age 53.08 ± 9.32, range 34-68 years) with
vesicovaginal (V-V) or vesicovaginorectal fistulae after external beam radiotherapy for cervical cancer treated
with two new shapes of continent gastric pouches were collected from 2002 to 2007. There were 12 pouches of
Shape 1 from 2002-2004 and 12 pouches of Shape 2 from 2004-2007. Pouchometry was performed after
operation with an average of 18.25 ± 13.6 months for Shape 1 and 6.92 ± 6.24 months for Shape 2 (range of Shape
1/Shape 2 = 1-36/3-24 months). Maximum pouch volume and volume at 30 cmH2O of pouch pressure or at 30
cmH2O of the amplitude of pressure wave, if there were contractions of the pouch, were assessed by aspiration.
Pouch volume at 30 cmH2O of intra-pouch pressure was classified into 4 grades, i.e. poor (volume of less than
200 mL), fair (volume of 200-300 mL), good (volume of 300-400 mL) and very good (volume of more than 400
mL). Complications such as metabolic disturbances, stomal skin excoriation, disruption or stenosis of skingastric
tube anastomosis and problem of catheterization were evaluated.
Results: There was no peri-operative mortality. After gastric pouch construction, three patients with
Shape 1 pouch died at 6, 8 and 30 months respectively; one with V-V fistula from external beam radiotherapy
developed generalized metastasis, another one with recurrent cervical cancer received chemotherapy and the
third one with arterial occlusion of left leg had severe pressure sore and septicemia after amputation. The Shape
1 pouch was triangular shaped or “Pizza puff” and Shape 2 was barrel-shaped. Average pouch volume at 30
cmH2O of Shape 1 (8 patients) was 396 ± 120.28 (range = 233-540) mL. Of these patients, four (50%) were very
good, two (25%) were good and two (25%) were fair. There was one who had leakage at volume of 233 mL and
had catheterization interval of 3-4 hours. Compared with patients of Shape 2 pouch (12 patients), average
volume at 30 cmH2O was 377.5 ± 117.41 (range = 200-550) mL (p = 0.76). In patients with the Shape 2 pouch,
4 (33.33%) were very good, 4 (33.33%) were good, and 4 (33.33%) were fair. For post-operative complications,
patients with Shape 1 pouch had catheterization difficulty with stomal skin excoriation in three cases and
stenosis of skin-gastric tube anastomosis in two cases. Two of Shape 2 pouch had partial disruption of skingastric
tube anastomosis with stomal skin excoriation and one had catheterization difficulty due to stenosis of
the anastomosis. Twenty three patients (95.83%) were dry with a catheterization interval of 4-6 hours. One
patient of Shape 2 pouch had right pouch-ureteral reflux (PUR). Mucous production of both pouch shapes was
clear and thin. Therefore, it was unnecessary to perform everyday pouch irrigation. Metabolic disturbance was
not found in this series.
Conclusions: The results of this study suggest that body segment of stomach is the best part of GI tract
to be used for creating urinary reservoir with good appearance and easy catheterization, especially of Shape 2
pouch. All are acceptable continence (dry interval of 3-6 hours) with safe pressure and easy care. No metabolic
abnormalities are found in early or late follow-up.