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In Reply.—Dr Braslow makes an interesting point. Preserving the entire ileum and the musculature surrounding its terminal end may indeed slow transit in and enhance absorption from the small intestine. Certainly, preserving the entire length of the small bowel right down to the ileocecal injunction should maintain maximum absorptive capacity. The hypothesis that slowing transit enhances absorption, however, has not received much support from our tests. We slowed transit by pacing the small intestine backward in our experiments, and this did not enhance absorption. It may be that a certain obligate volume output must be maintained by the small intestine to ensure healthy digestion and absorption of food, much as the kidney must excrete a certain amount of urine to maintain renal function. Nonetheless, further experiments should be done. Were ileostomy output to be decreased in some way, the state of chronic salt and water depletion of ileostomates would be
KELLY KA. Ileocecostomy-Reply. Arch Surg. 1988;123(6):782–783. doi:10.1001/archsurg.1988.01400300128027