A serous lined antireflux valve: In vivo fluorourodynamic evaluation of antireflux continence mechanism

We evaluate the fluoroscopic and urodynamic performance of a new serosal lined antireflux continence valve (T pouch valve) using an in vivo animal model. Materials and Methods: Intestinal reservoirs were constructed using an in vivo pig model. Multiple serosal lined valves of varying diameters and tunnel lengths were evaluated in the acute (immediately after construction) and chronic (4 weeks postoperatively) settings. Video fluorourodynamic evaluations were performed to identify valve leak point pressures and optimal tunnel length-to-luminal diameter ratios. Results: Four serosal lined valves tapered to a diameter of 18 and 30F in 1 and 2 cm. tunnels were evaluated. Immediately following construction of the valves no leakage was observed during reservoir filling (maximal pressure 50 cm. water) or external compression maneuvers to simulate a Valsalva maneuver (maximal intra-reservoir pressure 100 cm. water). Identical fluorourodynamic studies performed after a 4-week recuperation demonstrated leakage through the 30F, 1 cm, tunnel valve during reservoir filling (intra-reservoir pressure 19 cm. water). Increasing the tunnel length of the 30F system to 2 cm. (tunnel length-to-luminal diameter ratio 2:1) eliminated all evidence of valve leakage up to a maximal intra-reservoir pressure of 100 cm. water. Conclusions: These studies demonstrate the urodynamic characteristics of a new serosal lined valve. This easily constructed mechanism serves as a reliable antireflux (afferent) or continence (efferent) system.