LAUSR

ileal pouch torsion is a rare but significant complication after total proctocolectomy with iPaa. Patients often have significant adhesions after such an operation, which can make laparoscopic repair difficult. We demonstrate a laparoscopic repair of a pouch torsion with pexy in a patient with ulcerative colitis. after flexible pouchoscopy to detorse the ileal pouch, a rectal tube was placed for decompression. the patient was taken to the operating room for laparoscopic ileal pouch pexy. after abdominal inspection with the laparoscope, adhesions to the anterior pouch were identified as the likely source of the pouch torsion. these were dissected sharply. Visualization of the pouch staple line anteriorly indicated proper pouch orientation. the ileal pouch was then pexied to the left and right pelvic sidewalls using braided permanent suture, making sure not to injure the adjacent pelvic structures. an intraoperative flexible pouchoscopy was performed to evaluate the pouch orientation, and an additional permanent suture was placed to pexy the proximal pouch. mechanical abrasion was performed on the proximal mesentery to promote adhesion formation and prevent future torsion. the patient had an uneventful recovery and has been without complications for 3 years (see supplemental Digital Content 1–4, http://links.lww.com/DCR/a255, http://links. lww.com/DCR/a256, http://links.lww.com/DCR/a257, http://links.lww.com/DCR/a258). Laparoscopic Detorsion of an Ileal Pouch and Pouch Pexy