The use of an omental pedicle graft to prevent small-bowel obstruction after restorative proctocolectomy

Small-bowel obstruction remains one of the most frequent complications afte r restorative proctocolectomy with ileal pouch-anal anastomosis (IPAA), Of particular concern is small-bowel adhesion to the pelvic dead space that ca uses afferent limb obstruction, sometimes necessitating laparotomy. In this report, we describe a technique using an omental pedicle graft (OPG) to fi ll the pelvic dead space to prevent small-bowel obstruction and the resulti ng afferent limb obstruction after IPAA. The OPG is created from the left h alf of the omentum, while maintaining the blood supply from the left gastro epiploic vessels. The omentum is placed into the pelvis along the left para colic gutter from where the colon has been resected, It is then passed over the pelvic brim and placed behind and along the bilateral sides of the hea l pouch, filling the space. This modified technique was employed in the tre atment of four patients with chronic ulcerative, colitis, none of whom deve loped any signs of small-bowel obstruction.