Surgery Today

, Volume 29, Issue 4, pp 395–397

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

  • Tohru Nakagoe
  • Terumitsu Sawai
  • Takashi Tuji
  • Atushi Nanashima
  • Hiroyuki Yamaguchi
  • Tohru Yasutake
  • Hiroyoshi Ayabe
How to Do It

DOI: 10.1007/BF02483074

Cite this article as:
Nakagoe, T., Sawai, T., Tuji, T. et al. Surg Today (1999) 29: 395. doi:10.1007/BF02483074

Abstract

Small-bowel obstruction remains one of the most frequent complications after restorative proctocolectomy with ileal pouch-anal anastomosis (IPAA). Of particular concern is small-bowel adhesion to the pelvic dead space that causes afferent limb obstruction, sometimes necessitating laparotomy. In this report, we describe a technique using an omental pedicle graft (OPG) to fill the pelvic dead space to prevent small-bowel obstruction and the resulting afferent limb obstruction after IPAA. The OPG is created from the left half of the omentum, while maintaining the blood supply from the left gastroepiploic vessels. The omentum is placed into the pelvis along the left paracolic 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 ileal pouch, filling the space. This modified technique was employed in the treatment of four patients with chronic ulcerative colitis, none of whom developed any signs of small-bowel obstruction.

Key Words

omental pedicle graftrestorative proctocolectomysmall-bowel obstruction

Copyright information

© Springer-Verlag 1999

Authors and Affiliations

  • Tohru Nakagoe
    • 1
  • Terumitsu Sawai
    • 1
  • Takashi Tuji
    • 1
  • Atushi Nanashima
    • 1
  • Hiroyuki Yamaguchi
    • 1
  • Tohru Yasutake
    • 1
  • Hiroyoshi Ayabe
    • 1
  1. 1.First Department of SurgeryNagasaki University School of MedicineNagasakiJapan