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Pearls for the Small Bowel and Colon That Will Not Reach

  • Daniel I. Chu
  • Eric J. DozoisEmail author
Chapter

Abstract

Reestablishment of gastrointestinal continuity is a technically challenging but rewarding part of abdominal surgery. During reconstruction, surgeons may face a stressful situation in which the small bowel or colon “just does not reach,” either to the distal end for an anastomosis, or to the skin, to construct a stoma. With a detailed understanding of key embryologic planes and vascular anatomy, the techniques illustrated in this chapter can be used to allow construction of a safe anastomosis or stoma in almost all circumstances.

Keywords

Gastrointestinal continuity Tension-free anastomosis Mobilization Stoma Technique 

References

  1. 1.
    Kingham TP, Pachter HL. Colonic anastomotic leak: risk factors, diagnosis, and treatment. J Am Coll Surg. 2009;208(2):269–78.CrossRefPubMedGoogle Scholar
  2. 2.
    Trencheva K, et al. Identifying important predictors for anastomotic leak after colon and rectal resection: prospective study on 616 patients. Ann Surg. 2013;257(1):108–13.CrossRefPubMedGoogle Scholar
  3. 3.
    Morse BC, et al. Determination of independent predictive factors for anastomotic leak: analysis of 682 intestinal anastomoses. Am J Surg. 2013.Google Scholar
  4. 4.
    Slieker JC, et al. Systematic review of the technique of colorectal anastomosis. JAMA Surg. 2013;148(2):190–201.CrossRefPubMedGoogle Scholar
  5. 5.
    Sherwinter DA, Gallagher J, Donkar T. Intra-operative transanal near infrared imaging of colorectal anastomotic perfusion: a feasibility study. Colorectal Dis. 2013;15(1):91–6.CrossRefPubMedGoogle Scholar
  6. 6.
    Scott-Conner CEH. Chassin’s operative strategy in colon and rectal surgery. Vol. xv. New York: Springer; 2006. p. 283.CrossRefGoogle Scholar
  7. 7.
    Fischer JE. Fischer’s mastery of surgery. 6th ed. Philadelphia: Wolters Kluwer; 2012.Google Scholar
  8. 8.
    Beck DE, American Society of Colon and Rectal Surgeons. The ASCRS manual of colon and rectal surgery. Vol. xxvi. New York: Springer; 2009. p. 1046.Google Scholar
  9. 9.
    Brennan DJ, et al. Routine mobilization of the splenic flexure is not necessary during anterior resection for rectal cancer. Dis Colon Rectum. 2007;50(3):302–7. Discussion 307.CrossRefPubMedGoogle Scholar
  10. 10.
    Araujo SE, et al. Assessing the extent of colon lengthening due to splenic flexure mobilization techniques: a cadaver study. Arq Gastroenterol. 2012;49(3):219–22.CrossRefPubMedGoogle Scholar
  11. 11.
    Bonnet S, et al. High tie versus low tie vascular ligation of the inferior mesenteric artery in colorectal cancer surgery: impact on the gain in colon length and implications on the feasibility of anastomoses. Dis Colon Rectum. 2012;55(5):515–21.CrossRefPubMedGoogle Scholar
  12. 12.
    Smith L, Friend WG, Medwell SJ. The superior mesenteric artery. The critical factor in the pouch pull-through procedure. Dis Colon Rectum. 1984;27(11):741–4.CrossRefPubMedGoogle Scholar
  13. 13.
    Baig MK, et al. Lengthening of small bowel mesentery: stepladder incision technique. Am J Surg. 2006;191(5):715–7.CrossRefPubMedGoogle Scholar
  14. 14.
    Levine LA. Stepladder incision technique for lengthening of bowel mesentery. J Urol. 1992;148(2 Pt 1):351–2.PubMedGoogle Scholar
  15. 15.
    Uraiqat AA, CM Byrne, Phillips RK. Gaining length in ileal-anal pouch reconstruction: a review. Colorectal Dis. 2007;9(7):657–61.CrossRefPubMedGoogle Scholar
  16. 16.
    Cherqui D, et al. Inferior reach of ileal reservoir in ileoanal anastomosis. Experimental anatomic and angiographic study. Dis Colon Rectum. 1987;30(5):365–71.CrossRefPubMedGoogle Scholar
  17. 17.
    Martel P, et al. Mesenteric lengthening in ileoanal pouch anastomosis for ulcerative colitis: is high division of the superior mesenteric pedicle a safe procedure? Dis Colon Rectum. 1998;41(7):862–6. Discussion 866–7.CrossRefPubMedGoogle Scholar
  18. 18.
    Burnstein MJ, et al. Technique of mesenteric lengthening in ileal reservoir-anal anastomosis. Dis Colon Rectum. 1987;30(11):863–6.CrossRefPubMedGoogle Scholar
  19. 19.
    Martel P, et al. Comparative anatomical study of division of the ileocolic pedicle or the superior mesenteric pedicle for mesenteric lengthening. Br J Surg. 2002;89(6):775–8.Google Scholar
  20. 20.
    Araki T, et al. The effect on morbidity of mesentery lengthening techniques and the use of a covering stoma after ileoanal pouch surgery. Dis Colon Rectum. 2006;49(5):621–8.CrossRefPubMedGoogle Scholar
  21. 21.
    Goes RN, et al. Lengthening of the mesentery using the marginal vascular arcade of the right colon as the blood supply to the ileal pouch. Dis Colon Rectum. 1995;38(8):893–5.CrossRefPubMedGoogle Scholar
  22. 22.
    Chalmers RT, Bartolo DC. Anterior resection: right colon mobilization for colo-rectal anastomosis. J R Coll Surg Edinb. 1998;43(4):274–5.PubMedGoogle Scholar
  23. 23.
    Manceau G, et al. Right colon to rectal anastomosis (Deloyers procedure) as a salvage technique for low colorectal or coloanal anastomosis: postoperative and long-term outcomes. Dis Colon Rectum. 2012;55(3):363–8.CrossRefPubMedGoogle Scholar
  24. 24.
    Rombeau JL, Collins JP, Turnbull RB Jr. Left-sided colectomy with retroileal colorectal anastomosis. Arch Surgery. 1978;113(8):1004–5.CrossRefGoogle Scholar
  25. 25.
    Hogan NM, Joyce MR. Retroileal colorectal anastomosis: an old technique, still relevant. Tech Coloproctol. 2012.Google Scholar

Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  1. 1.Division of Gastrointestinal Surgery, Department of SurgeryUniversity of Alabama at Birmingham (UAB)BirminghamUSA
  2. 2.Division of Colon and Rectal Surgery, Department of Surgery,Mayo ClinicRochesterUSA

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