Optimizing results and techniques of mesenteric lengthening in ileal pouch-anal anastomosis

The techniques for ileoanal pull-through procedures have been well described previously. However, little attention has been given to the techniques to maximize ileal mesenteric length. Furthermore, no studies have provided data that support the technical recommendations. The purposes of this study are to describe our technique for ileal pouch construction and ileal mesenteric lengthening, and to provide data supporting our recommendations.

The operative summaries of 74 consecutive ileal J-pouch-anal anastomoses procedures were reviewed with attention to the management of the mesenteric vasculature.

Complete data with respect to the handling of the mesenteric circulation were available for 66 cases. Ileal J-pouch-anal anastomoses were achieved with both the ileal branch of the superior mesenteric artery and the ileocolic artery intact in 23% of cases. The ileocolic artery was divided in 48% of cases, and the ileal branch of the superior mesenteric artery was divided in 29% of cases. In addition, one or more distal arcade vessels between the vasa recta and the ileocolic artery were divided in 18% of cases. Ileal J-pouch-anal anastomosis was possible in all 74 patients.

These data emphasize the variability in mesenteric circulation and the complexity of pouch construction in patients undergoing ileoanal pull-through procedures. However, with attention to the techniques described, ileal J-pouch-anal anastomoses should be possible in virtually all patients.