BACKGROUND: The aim of this study was to analyze the efficacy of the preserved vascular arcade of the right colon (MVA) on maintaining blood perfusion to the pouch following mesenteric lenghtening maneuvers. METHODS: Forty six patients submitted to total proctocolectomy and ileal pouch-anal anastomosis for the treatment of ulcerative colitis (UC) and adenomatous familial polyposis (AFP), from January 1990 to July 2000, were divided in two groups: Group With Preservation of the Arcade (WPA), 27 patients, mean age 34,0 (19-53) years, 15 (55,6%) were female, and 24 (88,9%) were white; and Group Without Preservation of the Arcade (WOPA), 19 patients, mean age 41,5 (13-62) years, 8 were female (42,1%), and 18 (94,8%) were white. Thirty patients (65,2%) had UC and 16 (34,7%) had AFP. Analyzes were made by the comparison of the incidence of complications due to blood perfusion failure or overtension in the ileoanal anastomosis, as well as the need of revision operation. RESULTS: In the group WPA, 4 patients (14.8%) had complications being related to ischemia or anastomosis overtension. In the group WOPA, it was seen in 7 patients (36,9%). Three patients (11,1%) of the Group WPA were submitted on to revision operation due to complications related to ischemia or anastomotic overtension and 5 (26,3%) in the Group WOPA, for the same reasons. CONCLUSIONS: Besides methodological limitations, it was possible to identify a tendency to less occurrence of ischemia or anastomotic overtension related complications in the Group WPA. To perform a ileal pouch pull through operation, placing the anastomosis at the level of the pectinate line, the preserved MVA is an important technical aspect, helping to maintaining the viability and function of the pouch.
Ulcerative colitis; Familial adenomatous polyposis; Ileal pouch; Ileoanal anastomosis
