Comparison of Mesenteric Lengthening Techniques in IPAA: An Anatomic and Angiographic Study on Fresh Cadavers

İsmail, Erkin; Açar, Hali̇l İbrahi̇m; Arslan, Murat; Çoban, İ̇smail; Cömert, Ayhan; Aşlar, Ahmet Keşşaf; Kuzu, Mehmet Ayhan

doi:10.1097/dcr.0000000000001133

Cited by 12 publications

(18 citation statements)

References 15 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Several methods for enabling the ileal pouch to reach the anus have been reported, including sufficient mobilization of the small intestine, division of the mesenteric vessels supplying blood to the pouch, and performing transmesenteric incisions [ 6 - 16 ]. Cadaveric studies demonstrated the efficacy and safety of division of the ileocolic artery (ICA) or branches of the superior mesenteric artery (SMA) [ 6 , 7 , 10 , 12 , 16 ], and surgical results of each technique in single-center studies have been reported [ 5 , 8 , 9 , 11 , 13 , 14 , 17 ].…”

Section: Introductionmentioning

confidence: 99%

Risk factors for non-reaching of ileal pouch to the anus in laparoscopic restorative proctocolectomy with handsewn anastomosis for ulcerative colitis

et al. 2022

View full text Add to dashboard Cite

Background/Aims: Restorative proctocolectomy (RPC) with ileal pouch-anal anastomosis and handsewn anastomosis for ulcerative colitis requires pulling down of the ileal pouch into the pelvis, which can be technically challenging. We examined risk factors for the pouch not reaching the anus.Methods: Clinical records of 62 consecutive patients who were scheduled to undergo RPC with handsewn anastomosis at the University of Tokyo Hospital during 1989–2019 were reviewed. Risk factors for non-reaching were analyzed in patients in whom hand sewing was abandoned for stapled anastomosis because of nonreaching. Risk factors for non-reaching in laparoscopic RPC were separately analyzed. Anatomical indicators obtained from presurgical computed tomography (CT) were also evaluated.Results: Thirty-seven of 62 cases underwent laparoscopic procedures. In 6 cases (9.7%), handsewn anastomosis was changed to stapled anastomosis because of non-reaching. Male sex and a laparoscopic approach were independent risk factors of non-reaching. Distance between the terminal of the superior mesenteric artery (SMA) ileal branch and the anus > 11 cm was a risk factor for non-reaching.Conclusions: Laparoscopic RPC with handsewn anastomosis may limit extension and induction of the ileal pouch into the anus. Preoperative CT measurement from the terminal SMA to the anus may be useful for predicting non-reaching.

show abstract

Section: Introductionmentioning

confidence: 99%

Risk factors for non-reaching of ileal pouch to the anus in laparoscopic restorative proctocolectomy with handsewn anastomosis for ulcerative colitis

et al. 2022

View full text Add to dashboard Cite

show abstract

“…20 This results in mesenteric lengthening of approximately 3 to 6 cm in cadaveric studies. 24,25 In a small prospective review, this did not result in increased postoperative morbidity. 26 However, it is important to note that SMA ligation results in an increased distance between the distal ileum to the point of greatest reach which may necessitate resection of a short segment of small bowel to ensure proper pouch size.…”

Section: Sma Ligationmentioning

confidence: 90%

Intraoperative Techniques for Gaining Ileoanal Pouch Reach

Mankarious

Deutsch

Jeganathan

2022

Clin Colon Rectal Surg

View full text Add to dashboard Cite

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.

show abstract

“…Relaxing incisions, or "step ladder incisions," can be made anterior and posterior in the mesentery or windows within the mesentery (Fig. 9.4) [18]. Finally, transillumination of the mesentery can identify arcades providing points of safe mesenteric vessel transection, again enabling further lengthening of the mesentery for additional reach of the ileal reservoir for anal anastomosis [19].…”

Section: Small Bowel Mobilizationmentioning

confidence: 99%

Anastomotic Construction

Vargas

Margolin

2021

The ASCRS Textbook of Colon and Rectal Surgery

View full text Add to dashboard Cite

Anastomotic construction represents a fundamental and essential skill restoring intestinal continuity and preserving bowel function and continence.• It encompasses a broad range of methods and configurations and can be performed utilizing a spectrum of operative platforms. • While anastomosis may be a heterogeneous endeavor, consistent fundamental principles must be preserved in all its forms. • Stapling technologies represent a challenge for surgeon knowledge and understanding their use in clinical practice given the numerous innovations and specific tissuedevice interactions. • Colonic mobilization techniques bringing bowel into proximity to the distal limb while preserving blood supply represents an essential and critical skill for anastomotic construction. Surgeons must be familiar with advanced techniques for mobilization to achieve anastomosis.

show abstract

Comparison of Mesenteric Lengthening Techniques in IPAA: An Anatomic and Angiographic Study on Fresh Cadavers

Cited by 12 publications

References 15 publications

Risk factors for non-reaching of ileal pouch to the anus in laparoscopic restorative proctocolectomy with handsewn anastomosis for ulcerative colitis

Risk factors for non-reaching of ileal pouch to the anus in laparoscopic restorative proctocolectomy with handsewn anastomosis for ulcerative colitis

Intraoperative Techniques for Gaining Ileoanal Pouch Reach

Anastomotic Construction

Contact Info

Product

Resources

About