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Review
. 2022 Nov 2;35(6):458-462.
doi: 10.1055/s-0042-1758136. eCollection 2022 Nov.

Intraoperative Techniques for Gaining Ileoanal Pouch Reach

Marc M Mankarious  1 , Michael J Deutsch  1 , Nimalan A Jeganathan  1
Affiliations
Review

Intraoperative Techniques for Gaining Ileoanal Pouch Reach

Marc M Mankarious et al. Clin Colon Rectal Surg. .

Abstract

Ileal pouch-anal anastomosis allows for reestablishing gastrointestinal continuity in patients after proctocolectomy. The technical elements of pouch creation and gaining reach into the pelvis are demanding and require a variety of surgical maneuvers to achieve a tension-free anastomosis. We present a brief review of the literature discussing various approaches aimed at improving ileal pouch reach into the low pelvis. Although these techniques are used with different frequencies, they serve as important adjuncts to the gastrointestinal surgeons' armamentarium.

Keywords: J-pouch; ileal pouch anal anastomosis/IPAA; mesenteric lengthening; pouch reach.

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Conflict of interest statement

Conflict of Interest None declared.

Figures

Fig. 1
Fig. 1
Ileal pouch reach before ( A ) and after ( B ) division of avascular attachments to the duodenum and retroperitoneum. Dotted white line indicating inferior apex of midline abdominal incision. I-bar representing added length.
Fig. 2
Fig. 2
Diagram depicting ( A ) relationship between superior mesenteric artery (SMA), ileocolic artery ligation (ICA), and the bowstring of avascular mesentery with regards to terminal ileum and future pouch. ( B ) Added length with ICA ligation and excision of the bow-string with preservation of the SMA.
Fig. 3
Fig. 3
Selective ligation of collateral arteries to the ileal pouch. ( A ) Transillumination of the mesentery to define vascular arcade. ( B ) Creation of mesenteric window around a vessel in the second arcade. ( C ) Division of selected vascular artery.
Fig. 4
Fig. 4
( A ) Blood supply prior to colectomy with middle colic artery (MCA), superior mesenteric artery (SMA), right colic artery (RCA), and ileocolic artery (ICA). ( B ) Added length after colonic resection with preservation of right branch of MCA and right marginal artery with ligation of ICA, RCA, and distal SMA.
See this image and copyright information in PMC

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