Use of a jejunal pouch with ileal interposition in salvage surgery after restorative proctocolectomy.
OBJECTIVE
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.


CONCLUSIONS
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.
Dehni
N
N
Department of Digestive Surgery, Saint Antoine Hospital and Faculty of Medicine, University of Pierre and Marie Curie, Paris, France.
Cunningham
C
C
Parc
R
R
D000293:Adolescent; D000328:Adult; D001003:Anal Canal / Q000601:surgery*; D000714:Anastomosis, Surgical / Q000379:methods; D005260:Female; D006801:Humans; D007077:Ileal Diseases / Q000601:surgery; D007082:Ileum / Q000601:surgery*; D007583:Jejunum / Q000601:surgery; D008297:Male; D016737:Proctocolectomy, Restorative; D019651:Plastic Surgery Procedures / Q000379:methods*; D016879:Salvage Therapy; D016896:Treatment Outcome