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World J Surg. 2012 Jan;36(1):186-91. doi: 10.1007/s00268-011-1337-7.

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

Author information

1
Department of Surgery, St. John of God Hospital, Johannes von Gott Platz 1, 1020 Vienna, Austria.

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.

PMID:
22072431
DOI:
10.1007/s00268-011-1337-7
[Indexed for MEDLINE]

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