Mesenteric lengthening in ileoanal pouch anastomosis for ulcerative colitis: Is high division of the superior mesenteric pedicle a safe procedure?
OBJECTIVE
Lengthening of the mesentery is the technical key point of the ileoanal pouch procedure. Division of the superior mesenteric pedicle high in the mesentery is an original artifice that regularly provides sufficient descent of the pouch to reach the dentate line without any tension. A retrospective study compares two groups of patients with ulcerative colitis.


METHODS
Group 1 consisted of 21 patients with superior mesenteric pedicle division (mean lengthening, 6.1 cm), and Group 2 consisted of 44 patients without superior mesenteric pedicle division. Mortality and postoperative and late morbidity were studied along with functional outcome.


RESULTS
One patient died in Group 2 (postoperative pelvic sepsis); one patient died in Group 1 at six months from late liver transplant complications. Postoperative morbidity was insignificantly less important in Group 1 (P=0.02). Five patients in Group 2 had the pouch removed; none in Group 1 did. Pouchitis episodes developed in both groups, with no significant difference (P=0.5). Three patients in Group 1 developed anastomotic stenosis vs. 8 in Group 2 (P=0.5). Functional results at one-month, one-year, and two-year follow-ups are not significantly different, except that nighttime stool frequency increased in Group 2.


CONCLUSIONS
On the whole, morbidity and functional outcome appear similar. This suggests that high superior mesenteric pedicle division has no adverse effect and can be proposed routinely as an effective lengthening technique.
Department of Digestive Surgery, Hôpital Rothshild, Université de Paris VI, France.
P
P
Martel
N
N
Majery
B
B
Savigny
A
A
Sezeur
D
D
Gallot
M
M
Malafosse
D000328:Adult; D003093:Colitis, Ulcerative / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008643:Mesentery / Q000601:surgery*; D016737:Proctocolectomy, Restorative / Q000379:methods*; D012189:Retrospective Studies; D016896:Treatment Outcome