Document Detail

A new operative technique for restorative proctocolectomy: the endorectal pull-through combined with a double-stapled ileo-anal anastomosis.
MedLine Citation:
PMID:  14555938     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: In children, restorative proctocolectomy is usually accomplished by a rectal mucosectomy followed by a hand-sewn ileo-anal anastomosis+/-ileal pouch. In certain patients, a hand-sewn anastomosis can be technically difficult. This led us to develop a new technique that combines endorectal mucosectomy with a double-stapled ileo-anal anastomosis. METHODS: After colectomy, an ileal J-pouch is constructed. The head of the circular stapler is placed in the apex of the pouch and secured. An endorectal mucosectomy is completed from the abdomen to approximately 1.5 cm above the dentate line. The rectal mucosal/submucosal tube is everted onto the perineum. A transverse stapler is positioned 1.5 cm above the dentate line on the perineum and fired. The circular stapler is inserted transanally and the trocar advanced through the transverse staple line until the head and anvil are mated and then fired. A loop ileostomy is constructed. RESULTS: Thirteen patients, with a mean age of 12.3 years, have undergone endorectal mucosectomy with a double-stapled anastomosis without major complication. The operative time averaged 280+/-70 minutes. The mean 24-hour stool frequency, with 9 months' follow-up, was 6.8+/-3.2, of which 1+/-0.7 were at night. CONCLUSIONS: The combination of endorectal mucosectomy with a double-stapled anastomosis is a new approach for patients requiring restorative proctocolectomy. In our early experience, this technique was completed with a low complication rate and excellent functional results.
James D Geiger; Daniel H Teitelbaum; Ronald B Hirschl; Arnold G Coran
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Surgery     Volume:  134     ISSN:  0039-6060     ISO Abbreviation:  Surgery     Publication Date:  2003 Sep 
Date Detail:
Created Date:  2003-10-13     Completed Date:  2003-10-30     Revised Date:  2005-11-17    
Medline Journal Info:
Nlm Unique ID:  0417347     Medline TA:  Surgery     Country:  United States    
Other Details:
Languages:  eng     Pagination:  492-5     Citation Subset:  AIM; IM    
Department of Surgery, C S Mott Children's Hospital, University of Michigan Medical School, Ann Arbor, Michigan 48109-0245, USA.
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MeSH Terms
Anal Canal / surgery*
Anastomosis, Surgical / methods*
Child, Preschool
Follow-Up Studies
Ileum / surgery*
Proctocolectomy, Restorative / methods*

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