NEW DEVICE FOR ELECTIVE INVERSION OF THE NECROTIC ILEAL STUMP

Background: Leaving a necrotic ileal stump has been blamed as a cause of poor prognosis in jejunocaecal anastomosis. Elective inversion of the necrotic stump has been described by means of a nasogastric tube, although this procedure can be cumbersome and has been reported to cause caecocolic orifice occlusion. Objectives: To describe a new device and its use for elective inversion of necrotic ileal stump. Methods: The device was constructed securing 0.5 m of hemp tape to a 0.7 m of electrical cable puller. The device is inserted in the ileum and passed into the caecum. A TA90 stapler or USP 2 PDS suture is used to occlude the ileal lumen and simultaneously secure the tape to the intestine. The ileum is then resected. A small tiphlotomy is made at the proposed site for the jejunocaecal anastomosis. The device, protected by an arthroscopy sleeve, is retrieved by an assistant. The hemp tape is cut flush to the ileal mucosa. The tiphlotomy is closed. The device was tested ex-vivo for pullout force with a digital dynamometer and used in three clinical cases. Results: The device was easily secured to the intestine. Small enterotomies were sufficient both to insert and remove the device. Securing of the device to the intestine resulted effective both with TA stapler and sutures. Conclusions: The device resulted effective in inverting the ileal stump in clinical cases. Leaving a short, inverted stump, this method could help improving prognosis for jejunocaecal anastomosis, possibly avoiding undesired side effects of the procedure.