Techniques de sauvetage des anastomoses iléoanales avec réservoir

Abstract

Complete coloproctectomy with ileoanal anastomosis is a complex surgical act with a considerable associate rate of complications that jeopardise the reservoir in over 5% of the cases. These complications are mainly suppuration, anastomotic stenosis, reservoir ischemia, and functional disorders such as polyexoneration and pouchitis. Acute life-threatening complications impose suppressing the anastomosis and performing an ileostomy, but in case of delayed complications, after complete assessment, one or several re-interventions may be undertaken in order to preserve the reservoir. Most of these techniques of ileal pouch preservation can be performed by lower approach. They consist in the dilatation of an anastomotic stenosis that may be repeated, drainage of a perineal suppuration, reservoir lowering, and section of a residual septum in the reservoir. In case of failure, or when the reservoir lesions are diffuse and severe, intervention must be realised by both abdominal and perineal approaches. Following a total viscerolysis, the reservoir must be repaired, most of the time after disinsertion, then re-anastomosed with a quite systematic lateral ileostomy.