Abstract
PURPOSE: Creation of a safe ileal pouch requires a tension-free anastomosis. The aim of this study was to evaluate a technical procedure that increases the length of the mesentery while preserving the blood supply to the ileal pouch. HYPOTHESIS: Preservation of the marginal vascular arcade (MVA) of the right colon will allow ligation of more mesenteric vessels and increase the mesenteric length. METHODS: Six fresh cadavers were dissected. Measurement of the apex of the terminal ileum was done in relation to the pubic symphysis. Measurements were taken after 1) complete mobilization of the terminal ileum, right colon, and hepatic flexure; 2) vascular ligation between colon wall and the MVA, preserving the latter from the right branch of the middle colic artery to the ileal branch of the ileocolic artery (ICA); 3) ligation of the distal third of the superior mesenteric artery; 4) ligation of the ICA at its origin; 5) ligation of the right colon artery; and 6) division of the terminal ileal mesentery. RESULTS: This technique enabled complete division of the terminal ileal mesentery, adding a mean additional 3.6 (range, 2.5–5.0) cm (36.5±16.5 percent) in length to the mesentery, compared with superior mesenteric artery, ICA, and right colic artery ligation. CONCLUSION: Patients who have a shorter mesentery and concern of excessive mesenteric tension should have colectomy performed, preserving the MVA from the middle colic artery to the ileal branch of the ICA. The preserved MVA can be a reliable alternative blood supply to the pouch if more mesenteric vessel ligations are necessary.
Similar content being viewed by others
References
Cohen Z, McLeod RS. Proctocolectomy and ileoanal anastomosis with J-shaped or S-shaped ileal pouch. World J Surg 1988;12:164–8.
Kelly KA. Anal sphincter-saving operations for chronic ulcerative colitis. Am J Surg 1992;163:5–11.
McIntyre PB, Pemberton JH, Wolff BG, Beart RW, Dozois RR. Comparing functional results one year and ten years after ileal pouch-anal anastomosis for chronic ulcerative colitis. Dis Colon Rectum 1994;37:303–7.
Ballantyne GH, Graham SM, Hammers L, Modlin IM. Superior mesenteric artery syndrome following ileal J-pouch anal anastomosis: an iatrogenic cause of early postoperative obstruction. Dis Colon Rectum 1987;30:472–4.
Christie PM, Schroeder D, Hill GL. Persisting superior mesenteric artery syndrome following ileo-anal J pouch construction. Br J Surg 1988;75:1036.
Smith L, Friend WG, Medwell SJ. The superior mesenteric artery: the critical factor in the pouch pull-through procedure. Dis Colon Rectum 1984;27:741–4.
Burnstein MJ, Schoetz DJ Jr, Coller JA, Veidenheimer MC. Technique of mesenteric lengthening in ileal reservoir-anal anastomosis. Dis Colon Rectum 1987;30:863–6.
Nicholls RJ. Restorative proctocolectomy with various types of anastomosis. World J Surg 1987;11:751–62.
Cherqui D, Valleur P, Perniceni T, Hautefeuille P. Inferior reach of ileal reservoir in ileoanal anastomosis: experimental anatomic and angiographic study. Dis Colon Rectum 1987;30:365–71.
Williams NS, Johnston D. The current status of mucosal proctectomy and ileo-anal anastomosis in the surgical treatment of ulcerative colitis and adenomatous polyposis. Br J Surg 1985;72:159–68.
Gray H. Anatomy of the human body. 30th ed. Philadelphia: Lea & Febiger, 1985.
Siddharth P, Ravo B. Colorectal neurovasculature and anal sphincter. Surg Clin North Am 1988;68:1185–200.
Author information
Authors and Affiliations
Additional information
Dr. Goes is supported at the University of Southern California by grants from the Fundacao de Amparo a Pesquisa do Estado de Sao Paulo-FAPESP, Brazil.
About this article
Cite this article
Goes, R.N., Nguyen, P., Huang, D. et al. Lengthening of the mesentery using the marginal vascular arcade of the right colon as the blood supply to the ileal pouch. Dis Colon Rectum 38, 893–895 (1995). https://doi.org/10.1007/BF02049849
Issue Date:
DOI: https://doi.org/10.1007/BF02049849