Purpose: Tension-free ileal pouch-anal anastomosis (IPAA) in restorative proctocolectomy (RPC) for ulcerative colitis (UC) and familial adenomatous polyposis (FAP) is important for avoiding anastomotic complications. We have employed the elongation of ileocolic pedicle (ICP) with extended ileal resection as one of the mesenteric-lengthening techniques. In this study, we examined the feasibility and usefulness of our mesenteric-lengthening technique.

Methods: This retrospective study enrolled 60 patients for whom laparoscopic RPC with IPAA was electively planned for UC and FAP from January 2009 to December 2022. In 41 patients ("conventional group"), the ileum was cut flush to the cecum without ileal resection, and in 19 patients ("experimental group"), the elongation of the ICP with extended ileal resection was conducted. The short-term outcomes were compared between the two groups, and the risk factor for anastomotic complications was examined.

Results: The preoperative and intraoperative parameters did not differ between the two groups. However, the incidence of anastomosis-related complications (ARCs) was significantly lower in the experimental group than in the conventional group (0.0% versus 14.6%, respectively; p = 0.027). Univariate analysis demonstrated that the elongation of the ICP with extended ileal resection was significantly correlated with ARCs (p = 0.027 and p = 0.030, respectively), although multivariate analysis did not show the independent factors.

Conclusion: The lengthening technique using the elongation of the ICP with extended ileal resection is feasible and safe, and might be one choice for secure IPAA during the laparoscopic approach for RPC.

Keywords: Ileal J-pouch; Laparoscopic restorative proctocolectomy; Mesenteric lengthening; Sacrifice of the intestine.

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