ANATOMIC BASIS OF MESENTERIC ELONGATION FOR ILEOANAL ANASTOMOSIS WITHJ-SHAPED RESERVOIR - COMPARISON OF 2 TECHNIQUES OF VASCULAR SECTION

Total proctocolectomy followed by ileo-anal anastomosis with a reservo ir is the operation of choice for the treatment of familial adenomatou s polyposis and of certain forms of hemorrhagic proctocolitis. Vascula r section is sometimes necessary to enable the extremity of the reserv oir to reach the anal sphincter without traction. The aim of this stud y was to compare the gain in length obtained by two different techniqu es of vascular section and to assess in terms of the vascular anatomy of the last small intestinal loop which technique best preserved the v ascularisation of the reservoir as a whole. Twenty-two fresh cadavers had an ileal J-shaped reservoir of 18 cm fashioned from the last loop of small intestinal loop after section of the root of the mesentery. T he gains in length so obtained were measured after section of the ileo colic a. at its origin (group A) or section between the two vascular a rches of the last small intestinal loop (group B); the superior mesent eric vessels were then injected with colored resin. The gain in length obtained by these two methods was identical (2.3 +/- 1.1 cm for group A as against 2.18 +/- 0.9 cm for group B), but only if the section of the ileocolic a. was accompanied by section of the mesenteric periton eum up to the vascular arch formed by the anastomosis between the term inal branch of the superior mesenteric a. and the ileocolic a. The con stancy of this anastomosis always allowed section of the ileocolic a. while preserving good vascular distribution to the entirety of the res ervoir. Section between the two arches was difficult when the distance separating them was small.