Brief Clinical ReportsInterposition of a gastric pouch between ileum and anus after proctocolectomy: Long-term results in 3 patients
Section snippets
Operative technique
A midline xyphopubic laparotomy was performed. The gastrocolic and the gastrosplenic ligaments were cut carefully to avoid injuries to the right gastroepiploic vessels; the gastrophrenic ligament was preserved. The right gastroepiploic vessels were carefully dissected from the greater gastric curve, starting at their origin and then cephalad until a point located 15 cm from their end (the upper gastric branches of the gastroepiploic artery were thus preserved). The left half of the stomach was
Technique and postoperative period
The pouch was feasible in all 3 patients, and there were no technical complications. No residual rectal mucosa was found, and mucosectomy was not required. The pouch reached the dentate line with an average excess length of 10 cm. The median operation time was 255 minutes. The postoperative period was uneventful, and all patients were discharged within 10 days after the operation on a regular diet. The pouch was tested with a postoperative barium enema at 1 month; no fistulae were found (Fig 2
Discussion
The early postoperative course was uneventful in all 3 patients. There were no fistulae or septic complications. We believe the risk of leakage is low: The anastomosis between the ileum and the gastric pouch is as safe as gastroenteroanastomosis; the mechanical stapling and transection of the stomach is safe (and reinforced by continuous absorbable sutures); and the gastric pouch-anal anastomosis has a good blood supply and is tension free (excess length of the pouch is about 10 cm). There was
References (13)
- et al.
Functional assessment of ileal pouch-anal anastomotic techniques
Am J Surg
(1995) - et al.
Causes and outcomes of pouch excision after restorative proctocolectomy
Br J Surg
(2006) - et al.
Results and complications after ileal pouch anal anastomosis: a meta-analysis of 43 observational studies comprising 9,317 patients
Dig Surg
(2005) - et al.
Salvage reoperation for complications after ileal pouch-anal anastomosis
Br J Surg
(2005) - et al.
Long-term results of abdominal salvage surgery following restorative proctocolectomy
Br J Surg
(2006) - et al.
Improved outcome due to increased experience and individualized management of leaks after ileal pouch-anal anastomosis
Ann Surg
(2007)
Cited by (2)
Gastric pouch interposition after excision of an ileal pouch following septic complications: An alternative to definitive ileostomy
2023, Journal of Visceral SurgerySalvage procedures after restorative proctocolectomy: A systematic review and meta-analysis
2015, Journal of the American College of SurgeonsCitation Excerpt :In MacLean and colleagues'55 series, despite the poorer functional outcomes, the QoL of pouch reconstruction patients was similar to that for patients who had a successful initial IPAA. Satisfaction rates were reported at high levels throughout the few studies that incorporated this important variable in their SP patients' follow-up.36,48,67,83,84,89,105 The latter results apparently originate from the patients' contentment with maintaining their pouch and their ability to continue their lives without a stoma.
Presented in part at the 108th National Congress of Surgery of the French Association of Surgeons (AFC), October 2–6, 2006, Paris, France, and to the 15th World Congress of The International Association of Surgeons, Gastroenterologists (and Oncologists), May 25–28, 2006, Madrid, Spain.