Bridging the gap with an ileocolonic graft after extensive colorectal resections.

Abstract

BACKGROUND:

Ileocecal interposition (ICI) for first-line reconstruction after low anterior colorectal resection was introduced by von Flüe and Harder in 1994 (Dis Colon Rectum 37:1160-1162, 1994). We report our experience using this technique to bridge colonic gaps after significant loss of bowel length.

PATIENTS AND METHODS:

Between 1999 and 2009 the left-sided colon was too short for traditional isoperistaltic reconstruction in six patients treated in our hospital. Reasons for extensive bowel loss were a deficient (n = 3) or torn (n = 1) marginal artery with ischemia or repeat colorectal resections (n = 2). An ICI was done to bridge the gap and enable restoration of intestinal continuity.

RESULTS:

No patient died. Whenever performing a coloanal anastomosis (4/6) a loop ileostomy was raised. One patient with colonic diversion experienced graft-related complications: ischemic colitis of the interposed colonic segment, anastomotic stenosis, and a presacral sinus were observed and managed nonoperatively. Subsequent closure of the stoma was possible in all cases. A median Vaizey incontinence score of 9 (range: 4-14) was recorded in the patient with coloanal anastomosis. The average number of bowel movements per day was 1.5 (range: 0.5-6).

CONCLUSIONS:

When the descending colon does not reach the rectal stump or anal canal in reoperative cases or after vascular complication, ICI is a useful salvage procedure resulting in good bowel function.

• Authors: B Dauser, S Riss, J Stopfer, F Herbst
• Journal: World journal of surgery (World J Surg) Vol. 36 Issue 1 Pg. 186-91 (Jan 2012) ISSN: 1432-2323 [Electronic] United States
• PMID: 22072431 (Publication Type: Evaluation Study, Journal Article)

Topics

• Aged
• Anal Canal (surgery)
• Anastomosis, Surgical
• Cecum (transplantation)
• Colectomy
• Colon (surgery)
• Colorectal Neoplasms (surgery)
• Female
• Humans
• Ileum (transplantation)
• Intraoperative Complications
• Laparoscopy
• Length of Stay (statistics & numerical data)
• Male
• Middle Aged
• Postoperative Complications
• Rectum (surgery)
• Reoperation
• Retrospective Studies
• Treatment Outcome