Technique of mesenteric lengthening in ileal reservoir-anal anastomosis

Construction of a satisfactory ileal reservoir-anal anastomosis is dependent on the ability of the reservoir to reach the anus without tension. A technique has been developed for the generation of satisfactory mesenteric length in 159 consecutive J-reservoir procedures. By careful attention to technical details with particular reliance on the division of branches between the primary and secondary arcade vessels within the mesentery, sufficient length can be achieved in each case with an acceptable complication rate. When combined with the ease of construction of the J-reservoir, this technique of mesenteric lengthening has made the double-loop reservoir the procedure of choice.