MESENTERIC LENGTHENING IN ILEOANAL POUCH ANASTOMOSIS FOR ULCERATIVE-COLITIS - IS HIGH DIVISION OF THE SUPERIOR MESENTERIC PEDICLE A SAFE PROCEDURE

PURPOSE: Lengthening of the mesentery is the technical key point of th e ileoanal pouch procedure. Division of the superior mesenteric pedicl e high in the mesentery is an original artifice that regularly provide s sufficient descent of the pouch to reach the dentate line without an y tension. A retrospective study compares two groups of patients with ulcerative colitis. METHODS: Group 1 consisted of 21 patients with sup erior mesenteric pedicle division (mean lengthening, 6.1 cm), and Grou p 2 consisted of 44 patients without superior mesenteric pedicle divis ion. Mortality and postoperative and late morbidity were studied along with functional outcome. RESULTS: One patient died in Group 2 (postop erative pelvic sepsis); one patient died in Group I at six months from late liver transplant complications. Postoperative morbidity was insi gnificantly less important in Group 1 (P = 0.02), Five patients in Gro up 2 had the pouch removed; none in Group I did. Pouchitis episodes de veloped in both groups, with no significant difference (P = 0.5). Thre e 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 fol low-ups are not significantly different, except that nighttime stool f requency increased in Group 2, CONCLUSIONS: On the whole, morbidity an d 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.