What happens if the ileocecal valve is removed

Protein tends to slow the transit time of food, whereas simple sugars like juices or sweet foods can contribute to diarrhea. Low fat especially for people experiencing steatorrhea or people missing their terminal ileum. If fat malabsorption is occurring, supplements of vitamins A, D, E, and K are also recommended. Low oxalate for people missing their terminal ileum. High oxalate foods include: strawberries, spinach, rhubarb, chocolate, beets, tea, nuts, and wheat bran.

Foods that may control diarrhea are also recommended. These include bananas, oatmeal, rice, tapioca, applesauce, yogurt, etc. Multivitamin; magnesium, calcium, and iron supplements if duodenum removed ; Vitamin B12 if terminal ileum removed. Obertopet al. The hyperplasia reachhigherintensity in the ileum on the second postoperative week. In our experiment, we observed sign of hyperplasia of the mucosa in the colon just with the extensive small intestine resection, mainly when the ileocecal valve is preserved.

The morphological and functional repercussions found in experimental surgery were confirmed in clinical studies. Thompson 20 , studying large intestinal resections, noted that short bowel syndrome depends on some factors like: length of the resected intestine, resected segment jejunum or ileum , underlying intestinal disease, presence or absence of the ileocecal valve, and functional status of the other organsof the digestive system.

Rasslan et al. The jejunal resections were better tolerated, presenting slower intestinal transit, while patients with ileal resections got faster intestinal transit and steatorrhea. When the ileocecal valve was resected, they observed a higher hydroelectrolytic loss by the stoma and greater difficulty in adapting to the diet after feeding.

This clinical study supports the results of our experiment of the effect of ileocecal valve resection. Gouletet al. In our experiment, there was also no difference in mortality and body weight loss between the groups with and without valve.

The colon reacts actively in the adaptive response of extensiveenterectomy. Nundyet al. In our experiment, it was also observed hyperplasia on 30 th postoperative day. Using scanning electron microscopy, Tamames Gomez et al. We also observed these alterations in histometry. These histopathological alterations cause avicarious stimulus in the remaining colon due to the compensatory mechanism, trying to supply the metabolic needs created by the extensive intestinal resection.

The enlarged wall thickness of the remaining colon after extensive small bowel resection is caused by an increase in all its components. As it can be seen in statistic tables the exclusion of ileocecal valve is the main cause of significant improvement of the mucosa and muscular layer in comparison between GII e control group. Further research must be follow in order to explain if the intestinal of remnant small bowell content in the absence of ileocecal valve has a role in this response.

This response, like that observed in the remaining small intestine 16 , indicates an adaptive response that probably involves all digestive tract in largeenterectomies. In this experiment, was observed intense vascular proliferation in the chorion, severalmast cells, and an importantconjunctive proliferationin GII.

This aspect of theinfiltrateand other changes are like those stated by Allen 1 in the colon of patients who undergone ischemia.

We attributed the reddish color of the colon to the intense cellular hyperplasia of the various layers and the relative ischemia, related to an intense cellular proliferation not accompanied by corresponding vascularization. This finding was also observed by Milone et al.

Financial source: none. National Center for Biotechnology Information , U. Arq Bras Cir Dig. Published online Jan 7. Author information Article notes Copyright and License information Disclaimer.

Correspondence: Wangles Vasconcellos Soler E-mail: rb. Received Jul 10; Accepted Sep Copyright notice. This is an open-access article distributed under the terms of the Creative Commons Attribution License.

This article has been cited by other articles in PMC. Aim: To assess the impact of the ileocecal valve removal in a model of short bowel syndrome, in order to investigate the evolution of the colon under this circumstance. Results: Group I and II presented progressive loss of weight. Resultados: Grupos I e II apresentaram perda progressiva de peso. Patients who lost the ileocecal valve and part of the right colon had more diarrhea than those who lost comparable lengths of ileum but had this area preserved.

Fecal ion concentrations seemed independent of diet but were related to fecal weight and the amount of colon and ileum removed. Potassium concentration was strongly dependent on the amount of colon lost, while sodium concentration was more influenced by the length of resected ileum. A total of patients were considered. Applying the ERES method, the analysis of both questionnaires showed clinically and statistically significant improvement of HRQL at the end of the follow-up period. No significant deficiency in vitamin B12 levels was observed regardless of the length of surgical specimen.

In our series, no deterioration of HRQL and no vitamin B12 deficiency were found during the follow-up period. Nevertheless, warning patients about potential changes in bowel habits is mandatory. The ileocecal valve ICV , also defined as ileocecal junction, is a sphincter valve that separates the small bowel from the large bowel, regulating the passage of the chymus under influence of hormones and nerve fibers [ 1 , 2 ].

Removal of the ICV can lead to displacement of bacteria from the colon to the ileum and, under certain circumstances, it may result in a severe intestinal bacteria overgrowth SIBO syndrome, characterized by alteration in the number of bacteria in the upper gastrointestinal tract [ 3 , 4 ]. Symptoms are usually vague and non-specific, like abdominal discomfort, bloating, and diarrhea, but sometimes SIBO can lead to severe malabsorption, malnutrition, and vitamin B12 deficiency [ 4 , 5 , 6 , 7 , 8 ].

When considering vitamin B12 deficiency, it is important to note that, albeit this vitamin is actively absorbed exclusively in the terminal ileum, a small amount is passively absorbed throughout all the small bowel. Therefore, ileal resections shorter than 20 cm generally do not put patients at risk of developing vitamin B12 deficiency [ 9 ]. Since right colectomy and ileocecal resection are common surgical procedures performed for either malignant or benign diseases in both elective and emergency settings, patients often express their concern about potential postoperative functional outcomes.

Although rarely, in the long-term period some patients may report a clinically relevant worsening in bowel habits, as well as vitamin deficiency and deterioration of quality of life, which can be cause for medico-legal issues. In this context, the primary aim of the present study was to evaluate the intestinal activity and quality of life of patients with uncomplicated postoperative course following right colectomy or ileocecal resection, whatever the primary indication for surgery had been.

Secondly, postoperative vitamin B12 deficiency and possible supplementation requirements were assessed. This is a prospective, longitudinal, observational, multicentric study performed on patients referred to six Italian and one Slovenian colorectal surgery Centers between November and May Surgical procedures were performed by open, laparoscopic with either intra- or extra-corporeal anastomosis , or robotic approach.

The study was approved by all Centers Protocol Number , Local Ethical Committee of Trieste University Hospital and written informed consent was obtained by all participants. Operative data recorded for each patient included: age, gender, nature of disease i. Bowel function and quality of life before and after surgery were investigated by means of two validated questionnaires: the Gastrointestinal Quality of Life GIQLI questionnaire, which was administered to all patients with inflammatory, ischemic, or neoplastic disease, and the European Organization for Research and Treatment of Cancer EORTC QLQ-CR29 modules, which were selectively administered only to patients with neoplastic disease [ 12 , 13 , 14 ].

The GIQLI questionnaire was filled out by patients at the time of surgery, 2 weeks after surgery, and 6 weeks after surgery, evaluating the following selected items: abdominal pain, bloating, bowel frequency, bowel urgency, bowel movement, diarrhea, constipation, and nausea i. A five-point scale was used to indicate how symptoms affected patient's quality of life e.

A four-point scale was used to indicate how symptoms affected patient's quality of life e. In addition, blood samples for vitamin B12 levels were collected at the time of surgery, 3 months after surgery and 6 months after surgery. Correlation between vitamin B12 levels and length of resected small bowel was evaluated.

Categorical variables were reported as frequency and percentage. Non-parametric Friedman test for paired data was used for analysis of variation in scores between baseline and follow-up.

As post-hoc tests, pairwise comparisons were conducted using Wilcoxon signed rank test and corrected using the Holm method.

Statistically and clinically significant changes over time of questionnaire scores were evaluated. The severity of intervention-related symptoms was interpreted using minimal important difference MID determination evaluating a choice of specific items possibly influencing health-related quality-of-life HRQL outcomes in addition to the clinical significance of the intervention itself [ 16 , 17 ].

In addition, linear mixed-effects LME model was applied for longitudinal data to detect the most important parameters e. All p values were measured from two-sided tests with 0. All statistical analyses were conducted by R 3. The study analyzed a total of patients undergoing right colectomy, right extended colectomy, or ileocecal resection between November and May at six Italian and one Slovenian colorectal surgery Centers.

Of these, 87 Median range age was 71 16—91 years. The main indication for surgery was malignant disease, which was reported in According to AJCC classification, cancer patients were distributed as follows: 21 Cancer stage was not indicated in 2 1.

Overall, 46 Right colectomy was performed in Extended right colectomy was performed in 20 Ileocecal resection was performed in 3 1. Laparoscopy was the preferred surgical approach, regarding The median range length of the surgical specimen was 31 16— cm. When analyzing the total length of the ileum and the colon, median range lengths for each segment were 8 2— cm and 20 4—55 cm, respectively.

Table 1 summarizes the study population characteristics. Statistical analysis was performed only on patients completing the follow-up and a significant difference in symptoms between baseline and follow-up was recorded for all items, except for uncontrolled stools.

Over the 6-week follow-up period, a clinically relevant improvement of all examined items was observed, except for diarrhea. When considering chronic sequelae i. Applying the ERES method to the GIQLI questionnaire scores, the analysis showed that constipation significantly improved 2 weeks after surgery, maintaining its improvement at the 6-week follow-up, whereas diarrhea was found to significantly worsen 2 weeks after surgery before improving again at 6 weeks after surgery.

Results are summarized in Table 2 and Fig. Applying LME model for longitudinal data, the statistically significant correlation between clinical parameters and worsening of symptoms at 6 weeks after surgery is reported in Table 4 and Fig. Specifically, female gender was found to affect the frequency of abdominal pain, bloating, frequent bowel movements, diarrhea, and nausea.