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Use of a jejunal pouch with ileal interposition in salvage surgery after restorative proctocolectomy
N Dehni1, C Cunningham, R Parc
1Department of Digestive Surgery, Saint Antoine Hospital and Faculty of Medicine, University of Pierre and Marie Curie, Paris, France.
Purpose:
A novel technique is described for pouch reconstruction after failed restorative proctocolectomy and pouch excision.
Methods:
Surgery was undertaken in two patients who had undergone restorative proctocolectomy with subsequent excision of the ileal J-pouch after necrosis. At revisional surgery it was technically impossible to form a pouch using the terminal ileum because of mesenteric shortening. A new 18-cm J-pouch was formed with a jejunal segment. After selective division of axial vessels, adequate length was obtained to allow formation of a jejunal-pouch-anal anastomosis. The small bowel distal to the pouch was interposed between the proximal jejunum and J-pouch and a defunctioning stoma was made.
Results:
The postoperative course was uneventful in both cases. The functional results at 3 and 12 months after stoma closure were good, with five to seven bowel movements per day and complete continence.
Conclusion:
Shortening of the terminal ileal mesentery may preclude the formation of an ileal pouch in patients undergoing salvage surgery after failed restorative proctocolectomy. This novel technique of jejunal J-pouch formation and small-bowel interposition has value as an alternative to definitive ileostomy or Kock's pouch in such patients.