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April 1989

Endorectal Ileal Pullthrough-Reply

Author Affiliations

Los Angeles

Arch Surg. 1989;124(4):508. doi:10.1001/archsurg.1989.01410040118029

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In Reply. —We appreciate Dr Braslow's suggestions and recommendations regarding the endorectal ileal pullthrough procedure. As indicated in our article, the ileum is divided approximately 1 to 2 cm from the ileocecal valve unless there is active disease in the terminal ileum, in which case a small amount of ileum is resected. After mobilizing the superior mesenteric artery up to its origin from the aorta, the terminal ileum is divided approximately 15 cm from the end, but preserving the blood supply to the distal segment. The reservoir is constructed in a side-to-side manner over a distance of approximately 12 to 13 cm, which leaves an ileal "spout" distal to the lower end of the reservoir of approximately 1.5 to 2 cm.

With regard to preserving the ileocecal valve and a portion of ileum for the pullthrough segment, it has been our experience that almost all patients with ulcerative colitis will

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