Skip to Main Content

++
++
++
++
++
++
++
++
++
++

Many surgeons advocate leaving about 2 cm of mucosa above the columns. Recurrence of inflammatory bowel disease and malignant degeneration are possible and careful follow-up is essential. In general, avoidance of rectal dilatation or eversion of the stump plus a high level of anastomosis results in better fecal continence. In patients with high-grade dysplasia in the rectum, a traditional mucosectomy may be a better option, as it removes all the mucosa. If this technique is done, a hand-sewn ileoanal anastomosis would be required. The J-pouch is constructed by rotating the terminal ileum clockwise to create a “J”-shape (as seen from anteriorly) 15 cm long. The anterior ends are held by semicircular 000 silk sutures (Figure 6). The length is then checked as described above to ensure it will reach the pelvis. The distal antimesenteric end of the pouch is opened with electrocautery. A linear stapler is then inserted and fired, creating a pouch from the two limbs (Figure 7). Multiple firings are used to complete the full length of the pouch (to reach the upper end, the distal end is telescoped onto the stapler). A 2-0 Prolene suture is then used to create a “whip-stitch” purse-string suture around the opening in the tip of the pouch. An anvil of the circular stapler (EEA) is then inserted and the purse-string tied around it (Figure 8). The anvil must sit so that the anti-mesenteric aspect of the ileum is draped across it. The circular stapling (EEA) instrument is then inserted gently into the rectum by an assistant. It is advanced up to the level of the stapled rectal stump. The sharp spike then pierces through the stump at the staple line and it is approximated with the anvil (Figure 9). The device is then closed and fired, taking care not to include adjacent structures such as the vagina. Naive or too-vigorous insertion of the circular stapler (EEA) instrument will rip through the very short rectal stump and make the ...

Want remote access to your institution's subscription?

Sign in to your MyAccess profile while you are actively authenticated on this site via your institution (you will be able to verify this by looking at the top right corner of the screen - if you see your institution's name, you are authenticated). Once logged in to your MyAccess profile, you will be able to access your institution's subscription for 90 days from any location. You must be logged in while authenticated at least once every 90 days to maintain this remote access.

Ok

About MyAccess

If your institution subscribes to this resource, and you don't have a MyAccess profile, please contact your library's reference desk for information on how to gain access to this resource from off-campus.

Subscription Options

AccessSurgery Full Site: One-Year Subscription

Connect to the full suite of AccessSurgery content and resources including more than 160 instructional videos, 16,000+ high-quality images, interactive board review, 20+ textbooks, and more.

$995 USD
Buy Now

Pay Per View: Timed Access to all of AccessSurgery

24 Hour Subscription $34.95

Buy Now

48 Hour Subscription $54.95

Buy Now

Pop-up div Successfully Displayed

This div only appears when the trigger link is hovered over. Otherwise it is hidden from view.