Intest Res.  2022 Jul;20(3):313-320. 10.5217/ir.2020.00158.

Risk factors for non-reaching of ileal pouch to the anus in laparoscopic restorative proctocolectomy with handsewn anastomosis for ulcerative colitis

  • 1Department of Surgical Oncology, The University of Tokyo, Tokyo, Japan


Restorative proctocolectomy (RPC) with ileal pouch-anal anastomosis and handsewn anastomosis for ulcerative colitis requires pulling down of the ileal pouch into the pelvis, which can be technically challenging. We examined risk factors for the pouch not reaching the anus.
Clinical records of 62 consecutive patients who were scheduled to undergo RPC with handsewn anastomosis at the University of Tokyo Hospital during 1989–2019 were reviewed. Risk factors for non-reaching were analyzed in patients in whom hand sewing was abandoned for stapled anastomosis because of nonreaching. Risk factors for non-reaching in laparoscopic RPC were separately analyzed. Anatomical indicators obtained from presurgical computed tomography (CT) were also evaluated.
Thirty-seven of 62 cases underwent laparoscopic procedures. In 6 cases (9.7%), handsewn anastomosis was changed to stapled anastomosis because of non-reaching. Male sex and a laparoscopic approach were independent risk factors of non-reaching. Distance between the terminal of the superior mesenteric artery (SMA) ileal branch and the anus > 11 cm was a risk factor for non-reaching.
Laparoscopic RPC with handsewn anastomosis may limit extension and induction of the ileal pouch into the anus. Preoperative CT measurement from the terminal SMA to the anus may be useful for predicting non-reaching.


Handsewn anastomosis; Laparoscopy; Restorative proctocolectomy; Ulcerative colitis


  • Fig. 1. The distances between the horizontal contrast-enhanced computed tomography (CT) slices that contain the root of the SMA (rSMA) and the terminal of the ileal branch of the SMA (tSMA), which can be identified on the most caudal slice in the arterial phase of contrast-enhanced CT scans, and the upper margin of the anal canal (AC) were measured. SMA, superior mesenteric artery.

  • Fig. 2. The distances between the ischium at the level of the femoral head (d-Sci) in the axial view (A), from the promontory angle to the suprapubic margin (d-inlet), and from the coccyx to the inferior pubic margin (d-outlet), in the sagittal view (B), were also measured.


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