title: How I do it: the stapled ileal J pouch at restorative proctocolectomy.
abstract: BACKGROUND
  Ileal pouch-anal anastomosis (IPAA) following proctocolectomy is the preferred option for patients with medically refractory ulcerative colitis, indeterminate colitis, and familial adenomatous polyposis. However, it remains a procedure associated with morbidity and mortality. Pelvic sepsis, pouch fistulae, and anastomotic dehiscence predispose to pouch failure. We report our experience with an adaptation for the formation of the stapled ileal J pouch using the GIA™ 100 stapling device (Covidien, Mansfield, Massachusetts, USA). When creating the J pouch, we remove the bevelled plastic protector from the thin fork of the stapling device, allowing the staple line to be completed to the tip of the stapled efferent limb of the pouch, thereby minimizing potential blind ending in the efferent limb and injury to the transverse staple line.
  
  
  METHODS
  Patients undergoing elective IPAA at our institution over a 5-year period using this adapted stapling technique for creation of the ileal J pouch were reviewed. Data were collected from a prospectively maintained inflammatory bowel disease database, theater records, and patient chart review.
  
  
  RESULTS
  Forty-one patients underwent IPAA using this technique at our institution during the study period. Postoperative morbidity was encountered in 11 of 41 patients including pelvic sepsis, pouch fistulae, anastomotic stricture, or leak. There was no morbidity observed related to a blind efferent limb or transverse staple line disruption. No mortality was observed in this series.
  
  
  CONCLUSIONS
  Maximizing the length of the efferent fork of the GIA stapling device can reduce the length of redundant efferent J limb of the ileal J pouch. This may reduce the incidence of torsion, volvulus, distension, fistulae/sinuses, and pelvic sepsis/anastomotic leak following IPAA.
authors: Institute for Clinical Outcomes Research and Education (iCORE), Department of Surgery, St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland.
authors: S T
authors: ST
authors: Martin
authors: R
authors: R
authors: Tevlin
authors: A
authors: A
authors: Heeney
authors: C
authors: C
authors: Peirce
authors: J M
authors: JM
authors: Hyland
authors: D C
authors: DC
authors: Winter
mesh_terms: D001003:Anal Canal / Q000601:surgery; D039021:Colonic Pouches; D004867:Equipment Design; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015212:Inflammatory Bowel Diseases / Q000601:surgery*; D007494:Ireland / Q000453:epidemiology; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology; D016737:Proctocolectomy, Restorative / Q000379:methods*; D011446:Prospective Studies; D011788:Quality of Life; D017792:Surgical Stapling / Q000295:instrumentation*; D013997:Time Factors; D016896:Treatment Outcome