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CC BY-NC-ND 4.0 · Journal of Coloproctology 2021; 41(04): 438-442
DOI: 10.1055/s-0041-1736466
Review Article

Mesenteric Lengthening in Pouch Surgery: Review of Surgical Techniques

Melissa Kyriakos Saad 
1   General Surgery Department, Saint George Hospital University Medical Center, Beirut, Lebanon
3   Department of Surgery, University of Balamand, Beirut, Lebanon
,
Elias Fiani 
2   Gastroenterology Department, Saint George Hospital University Medical Center, Beirut, Lebanon
3   Department of Surgery, University of Balamand, Beirut, Lebanon
,
Elias Saikaly 
1   General Surgery Department, Saint George Hospital University Medical Center, Beirut, Lebanon
3   Department of Surgery, University of Balamand, Beirut, Lebanon
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Abstract

Described for the first time in the medical literature in 1978 by Parks and Nicholls, total proctocolectomy with ileal-pouch anal anastomosis (IPAA) is nowadays the procedure of choice for patients with ulcerative colitis in whom the medical therapy has, a selected group of patients with Crohńs disease, and for patients with familial adenomatous polyposis. Despite the advances in medical treatment regarding inflammatory bowel disease, up to 30% of patients still require surgery, and restorative proctocolectomy and IPAA are the mainstay of the surgical treatment. It is considered a demanding and technically-challenging procedure, with the main challenge being the performance of a tension-free IPAA; the main reason for failure of the tension-free anastomosis is a shortened mesentery. With particular attention to detail, sufficient length can be achieved to enable a safe anastomosis in most patients. Herein, we describe the available techniques to lengthen the mesentery of the ileal pouch to perform an easy-to-reach tension-free anastomosis.

Keywords

pouch surgery - mesenteric lengthening


Publikationsverlauf

Eingereicht: 19. Februar 2021

Angenommen: 06. August 2021

Artikel online veröffentlicht:
13. Dezember 2021

© 2021. Sociedade Brasileira de Coloproctologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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  • References

  • 1 Parks AG, Nicholls RJ. Proctocolectomy without ileostomy for ulcerative colitis. BMJ 1978; 2 (6130): 85-88
    CrossrefPubMedSuche in Google Scholar
  • 2 Kelly KA. Anal sphincter-saving operations for chronic ulcerative colitis. Am J Surg 1992; 163 (01) 5-11
    CrossrefPubMedSuche in Google Scholar
  • 3 McIntyre PB, Pemberton JH, Wolff BG, Beart RW, Dozois RR. Comparing functional results one year and ten years after ileal pouch-anal anastomosis for chronic ulcerative colitis. Dis Colon Rectum 1994; 37 (04) 303-307
    CrossrefPubMedSuche in Google Scholar
  • 4 Martel P, Majery N, Savigny B, Sezeur A, Gallot D, Malafosse M. Mesenteric lengthening in ileoanal pouch anastomosis for ulcerative colitis: Is high division of the superior mesenteric pedicle a safe procedure?. Dis Colon Rectum 1998; 41 (07) 862-866 , discussion 866–867
    CrossrefPubMedSuche in Google Scholar
  • 5 Burnstein MJ, Schoetz Jr DJ, Coller JA, Veidenheimer MC. Technique of mesenteric lengthening in ileal reservoir-anal anastomosis. Dis Colon Rectum 1987; 30 (11) 863-866
    CrossrefPubMedSuche in Google Scholar
  • 6 Lewis WG, Kuzu A, Sagar PM, Holdsworth PJ, Johnston D. Stricture at the pouch-anal anastomosis after restorative proctocolectomy. Dis Colon Rectum 1994; 37 (02) 120-125
    CrossrefPubMedSuche in Google Scholar
  • 7 Smith L, Friend WG, Medwell SJ. The superior mesenteric artery. The critical factor in the pouch pull-through procedure. Dis Colon Rectum 1984; 27 (11) 741-744
    CrossrefPubMedSuche in Google Scholar
  • 8 Ross H, Steele SR, Varma M. et al; Standards Practice Task Force of the American Society of Colon and Rectal Surgeons. Practice parameters for the surgical treatment of ulcerative colitis. Dis Colon Rectum 2014; 57 (01) 5-22
    CrossrefPubMedSuche in Google Scholar
  • 9 Fazio VW, Kiran RP, Remzi FH. et al. Ileal pouch anal anastomosis: analysis of outcome and quality of life in 3707 patients. Ann Surg 2013; 257 (04) 679-685
    CrossrefPubMedSuche in Google Scholar
  • 10 Selvaggi F, Sciaudone G, Limongelli P. et al. The effect of pelvic septic complications on function and quality of life after ileal pouch-anal anastomosis: a single center experience. Am Surg 2010; 76 (04) 428-435
    CrossrefPubMedSuche in Google Scholar
  • 11 Papadopoulos VN, Michalopoulos A, Apostolidis S. Ileal pouch dysfunction. Tech Coloproctol 2010; 14 (Suppl. 01) S83-S85
    CrossrefPubMedSuche in Google Scholar
  • 12 Ballantyne GH, Pemberton JH, Beart Jr RW, Wolff BG, Dozois RR. Ileal J pouch-anal anastomosis. Current technique. Dis Colon Rectum 1985; 28 (03) 197-202
    CrossrefPubMedSuche in Google Scholar
  • 13 Chun HK, Smith LE, Orkin BA. Intraoperative reasons for abandoning ileal pouch-anal anastomosis procedures. Dis Colon Rectum 1995; 38 (03) 273-275
    CrossrefPubMedSuche in Google Scholar
  • 14 Chu DI, Tognelli J, Kartheuser AH, Dozois EJ. Strategy for the difficult-to-reach ileal pouch-anal anastomosis: technical steps of an in vivo application of a mesenteric-lengthening technique. Tech Coloproctol 2015; 19 (11) 705-709
    CrossrefPubMedSuche in Google Scholar
  • 15 Ohira G, Miyauchi H, Narushima K. et al. Predicting difficulty in extending the ileal pouch to the anus in restorative proctocolectomy: investigation of a simple predictive method using computed tomography. Colorectal Dis 2017; 19 (01) O34-O38
    CrossrefPubMedSuche in Google Scholar
  • 16 Thirlby RC. Optimizing results and techniques of mesenteric lengthening in ileal pouch-anal anastomosis. Am J Surg 1995; 169 (05) 499-502
    CrossrefPubMedSuche in Google Scholar
  • 17 Baig MK, Weiss EG, Nogueras JJ, Wexner SD. Lengthening of small bowel mesentery: stepladder incision technique. Am J Surg 2006; 191 (05) 715-717
    CrossrefPubMedSuche in Google Scholar
  • 18 Uraiqat AA, Byrne CM, Phillips RK. Gaining length in ileal-anal pouch reconstruction: a review. Colorectal Dis 2007; 9 (07) 657-661
    Suche in Google Scholar
  • 19 Kirat HT, Remzi FH, Kiran RP, Fazio VW. Comparison of outcomes after hand-sewn versus stapled ileal pouch-anal anastomosis in 3,109 patients. Surgery 2009; 146 (04) 723-729 , discussion 729–730
    CrossrefPubMedSuche in Google Scholar
  • 20 Remzi FH, Fazio VW, Delaney CP. et al. Dysplasia of the anal transitional zone after ileal pouch-anal anastomosis: results of prospective evaluation after a minimum of ten years. Dis Colon Rectum 2003; 46 (01) 6-13
    CrossrefPubMedSuche in Google Scholar
  • 21 Michelassi F, Lee J, Rubin M. et al. Long-term functional results after ileal pouch anal restorative proctocolectomy for ulcerative colitis: a prospective observational study. Ann Surg 2003; 238 (03) 433-441 , discussion 442–445
    CrossrefPubMedSuche in Google Scholar
  • 22 McHugh SM, Diamant NE, McLeod R, Cohen Z. S-pouches vs. J-pouches. A comparison of functional outcomes. Dis Colon Rectum 1987; 30 (09) 671-677
    CrossrefPubMedSuche in Google Scholar
  • 23 Cherqui D, Valleur P, Perniceni T, Hautefeuille P. Inferior reach of ileal reservoir in ileoanal anastomosis. Experimental anatomic and angiographic study. Dis Colon Rectum 1987; 30 (05) 365-371
    CrossrefPubMedSuche in Google Scholar
  • 24 Martel P, Blanc P, Bothereau H, Malafosse M, Gallot D. Comparative anatomical study of division of the ileocolic pedicle or the superior mesenteric pedicle for mesenteric lengthening. Br J Surg 2002; 89 (06) 775-778
    CrossrefPubMedSuche in Google Scholar
  • 25 Rottoli M, Tanzanu M, Lanci AL, Gentilini L, Boschi L, Poggioli G. Mesenteric lengthening during pouch surgery: technique and outcomes in a tertiary centre. Updates Surg 2021; 73 (02) 581-586
    CrossrefPubMedSuche in Google Scholar
  • 26 Goes RN, Nguyen P, Huang D, Beart Jr RW. Lengthening of the mesentery using the marginal vascular arcade of the right colon as the blood supply to the ileal pouch. Dis Colon Rectum 1995; 38 (08) 893-895
    CrossrefPubMedSuche in Google Scholar