Gaining length in ileal-anal pouch reconstruction: a review

Objective Construction of a satisfactory ileal reservoir‐anal anastomosis is dependent on the ability of the reservoir to reach the anus without tension. Method A literature review of English language scientific papers from Medline and Pubmed between 1978 and 2004 about ileal pouch surgery techniques was conducted. Results The critical factor in tension free pouch construction is the length and reach of the superior mesenteric artery. There are a variety of techniques for lengthening the small bowel mesentery including the precise location of division of the ileocolic artery and other mesenteric vessels, mesenteric peritoneal relaxing incisions, folding of the pouch and differences between stapled and handsewn anastomosis and pouch construction. Conclusion With particular attention to detail, sufficient length can be achieved to permit safe anastomosis in most patients.