Related Experiment Video
Updated: Jan 20, 2026
Author Spotlight: Developing a Rat Model for Pouchitis Research and Treatment
Published on: May 31, 2024
Utilization of Maneuvers to Increase Mesenteric Length Employed in Children Undergoing Ileal Pouch-Anal Anastomosis
Michael D Traynor1,2, Nicholas P McKenna1, Elizabeth B Habermann1,3,4
1Department of Surgery, Mayo Clinic, Rochester, Minnesota.
Insights
Mesenteric lengthening maneuvers are often needed during pediatric ileal pouch-anal anastomosis (IPAA) surgery, especially for overweight or obese children. These maneuvers ensure a tension-free anastomosis without increasing short-term complications.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Surgical Oncology
Background:
- Ileal pouch-anal anastomosis (IPAA) is a complex procedure.
- Mesenteric lengthening maneuvers are common in adults but understudied in pediatric patients.
- Obesity is a growing concern in pediatric surgical populations.
Purpose of the Study:
- To evaluate the utilization and impact of mesenteric lengthening maneuvers in pediatric IPAA.
- To identify patient factors associated with the need for these maneuvers.
- To assess short-term postoperative complications in relation to maneuver use.
Main Methods:
- Retrospective chart review of pediatric patients (<18 years) undergoing IPAA.
- Analysis of patient demographics, operative details, and 30-day postoperative outcomes.
- Classification of BMI percentile and statistical analysis to determine factors associated with maneuver use.
Main Results:
- 66% of pediatric IPAA cases required mesenteric lengthening maneuvers.
- Overweight/obese children were significantly more likely to require maneuvers (93% vs. 61%).
- Obesity was an independent risk factor for requiring maneuvers (OR 9.3).
Conclusions:
- Mesenteric lengthening maneuvers are frequently necessary in pediatric IPAA.
- Surgeons should anticipate performing these maneuvers, particularly in obese children.
- The long-term impact of these maneuvers on pouch function requires further investigation.
Abstract:
Operative maneuvers to increase mesenteric length during ileal pouch-anal anastomosis (IPAA) are frequently utilized in adults, but limited data exist on the need for their use in children. A retrospective chart review of children (age <18) considered for IPAA creation at two affiliated tertiary referral centers from 2007 to 2017 was conducted, and patient factors, operative details, and 30-day postoperative complications were abstracted. Body mass index (BMI) was normalized to BMI percentile-for-age-and-sex and classified as underweight (BMI <5th percentile), healthy weight (5th ≤ BMI percentile <85th), or overweight/obese (BMI ≥85th percentile). Maneuvers were identified from operative notes. Univariate analysis and multivariable logistic regression were performed to determine independent factors associated with the use of maneuvers. A total of 94 patients underwent attempt at IPAA creation, which was successful in 91 (97%). Fourteen (15%) of 91 patients were classified as overweight or obese. The 3 failures occurred secondary to inability to reach in 3 patients, with specific mention of patients' obesity in 2 and pouch ischemia in 1. Sixty (66%) patients required maneuvers to lengthen the mesentery. Overweight/obese patients required maneuvers more often than nonoverweight/obese patients (93% versus 61%, P = .03). There were no differences in 30-day maximum Clavien-Dindo scores between patients with and without maneuvers performed (P = .83). Being overweight/obese was an independent risk factor for requiring maneuvers (odds ratio: 9.3, 95% confidence interval: 1.1-82.8) after adjusting for age, sex, height, operative stage, and surgeon. Surgeons should be prepared to perform mesenteric lengthening maneuvers when operating on pediatric patients to ensure minimal tension on the IPAA, and more so when operating on obese children. Whether these maneuvers have an impact on long-term pouch function is undetermined.
Related Concept Videos
04:05A Rat Model of Pouchitis Following Proctocolectomy and Ileal Pouch-Anal Anastomosis Using Dextran Sulfate Sodium
06:40Single-Anastomosis Duodeno-Ileal Bypass with Sleeve Gastrectomy Model in Mice
07:22Creation of Colonic Anastomosis in Mice
07:51The C-seal: A Biofragmentable Drain Protecting the Stapled Colorectal Anastomosis from Leakage
07:34Microsurgical Venous Pouch Arterial-Bifurcation Aneurysms in the Rabbit Model: Technical Aspects
04:35Murine Ileal Resection Model: Studying Ileectomy-Induced Bile Metabolism in Murine Model