This video is centered on the recommendations of how to build a J pouch of the small bowel.
This patient had a previous history of a total colectomy plus an end ileostomy, requiring a proctectomy as the present surgical procedure.
The first step is to take down the ileostomy, dissecting from the skin to the muscular fascia. A fasciotomy is performed in order to allow the introduction of the pouch into the abdominal cavity.
The distal ileum is externalized and the mesenterium is sectioned to release the bowel that will be sectioned with a mechanical suture.
Two loops of continuous small bowel are measured (18 cm each) and placed in parallel, an enterotomy is performed in the antimesenteric edge at the middle of the future pouch that is used as a route of entrance for the mechanical suture into the lumen of the small bowel.
Several firings are made towards the proximal part of the pouch, the mechanical suture creates a common cavity inside. It is important to verify that the loops are placed symmetrically and not twisted, one firing is made towards the distal part.
The last enterotomy is made in the zone of the reservoir that will be part of the ileo-anal anastomosis, it is used to fire the last mechanical sutures, completing the pouch cavity.
A knot is made to maintain together the bowel loops and avoid tension.
The medial enterotomy is closed with a mechanical suture, the anvil shaft is fixated with a prolene purse string at the other enterotomy for an ileo-anal mechanical anastomosis.