Long Efferent Limb

Parks and Nicholls's S-pouch [35] or Fonkalsrud's H-pouch [22] can determine the formation of an efferent limb of the terminal ileum, which constitutes the proximal side of ileo-anal anastomosis. A long efferent limb (LEL), >8 cm of length, fashioned in the first "debut" cases of the S-reservoir, needed catheterisa-tion of the pouch to achieve evacuation in more than 50% of the patients [36].

Fonkalsrud [22], in his study of 601 PRs, reports an OO rate of 27.3%, with a success rate after surgical review in 93% of cases. In this experience, however, 221 patients had an H-reservoir and 4 had an S-reser-voir constructed in the early 1980s. Those made at that time were abandoned because of an elevated incidence of emptying with the necessity of catheter-isation.

The removal of the LEL is possible through a transanal approach, but it is technically feasible in less than 30% of patients [22,37]. The technique consists of mobilisation of the pouch and separation of the ileo-anal anastomosis. The efferent limb is removed and a new manual anastomosis is fashioned between the pouch and the anal canal.

Sagar [10], in a study of 1 770 ileal pouches, evidenced 9 LELs (5-11 cm), all of which were in patients with an S-pouch, and 3 blind handle torsions in patients with J-pouches. After surgical treatment of the nine patients with LEL, five demanded construction of a new reservoir, which was successful in seven cases (78%). In the three patients with blind handle torsions, he did not fashion a new reservoir and only one patient benefited from the surgical treatment. Of a total of 26 patients who underwent this treatment, failure of the surgical procedure was recorded in 5, while 18 showed improvement which included a change from needing catheterisation to spontaneous evacuation [9,10, 37, 38].

Was this article helpful?

0 0
Mole Removal

Mole Removal

Moles, warts, and other unsightly irregularities of the skin can be bothersome and even embarrassing. They can be removed naturally... Removing Warts and Moles Naturally! If you have moles, warts, and other skin irregularities that you cannot cover up affecting the way you look, you can have them removed. Doctors can be extremely expensive. Learn the natural ways you can remove these irregularities in the comfort of your own home.

Get My Free Ebook


Post a comment