The steps that are the same are: 55-60 cm ileum used, scissor detubularization of the ileum, sewn pouch construction, equal cross folding, externalized and direct ureteral stenting, globular shape and the presence of an afferent limb.
The hiccup center may be activated by a great variety of stimuli travelling along different nerve pathways and a reflex arc has been proposed, with the phrenic nerves, vagi, and T6-12 sympathetic fibers as the afferent limb. (1) The "hiccup centre" is thought to be located in either the brainstem respiratory centre or the cervical cord between segments C3 and C5.
Debate continues as to whether using intusscepted ileum in the afferent limb (inlet) to create a nipple valve, as in the Kock pouch, is necessary to prevent reflux that could eventually damage the upper tracts (Elmajian et al., 1996).
The reflex arc(2) for hiccups comprises: (1) the afferent limb: phrenic nerve, vagus nerve, or thoracic sympathetic fibers; (2) the central connection: not a specific center, more an interaction among brain stem respiratory system, phrenic nerve nuclei, reticular formation, and hypothalamus; and (3) the efferent limb: primarily the phrenic nerve.