Comparative anatomical study of division of the ileocolic pedicle or the superior mesenteric pedicle for mesenteric lengthening

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Abstract
Background: Lengthening of the mesentery by vascular division may be necessary to perform an ileal pouch–anal anastomosis without tension. The aim of this study was to compare, in fresh cadavers, the increase in mesentery length after division of the ileocolic pedicle (ICP) and the superior mesenteric pedicle (SMP). Methods: Total colectomy was performed in 12 fresh cadavers, which were then randomly divided into two groups. Pouch–anal anastomosis was performed with division of the ICP in one group of six cadavers and with division of the SMP in the other. The ileum was measured and the increase in length was recorded and compared statistically. Results: The mean(s.d.) increase in length was 3·0(0·8) cm after ICP division and 6·5(1·1) cm after SMP division (P < 0·001). The distance between the end of the ileum and the point giving the greatest length was 25·5(5·0) cm in the ICP group and 46·8(4·2) cm in SMP group (P < 0·001). Conclusion: In fresh cadavers, the increase in mesenteric length was greater after SMP division than after ICP division, but if pouch–anal anastomosis is performed a short segment of small bowel must be removed.

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