This procedure is useful for a patient who requires antegrade enema therapy, but has had his or her appendix removed in a prior operation. The patient requires a preoperative mechanical bowel prep. Through either a midline incision or a transverse incision in the right upper quadrant, the cecum is adequately mobilized. The lumen of the midright colon and ileum are occluded with vessel loops.
The right colon just distal to the ileocecal valve is inspected. The cecal flap is created 10 to 12 mm wide and 4 to 5 cm long. It is based on a vessel which is visible both in the mesentery and continuing into the wall of the cecum. Silk stay sutures are placed in the cecum as well as within the cecal flap. The flap is then outlined with a marking pencil and incised with the cautery.
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