Small bowel conduit

Principles

• Must divide back at level of jejunal branches, not the arcades or vasa rectae, to prevent ischaemia
• If making a free graft, it technically could be any section of jejunum which gets used. However, the largest arteries are found proximally, so that is generally best.

Technique

• Divide mesentery just beyond the DJ flexure
• A point on jejunum 20-25cm distal to DJ flexure usually corresponds to 3rd or 4th jejunal artery, and should give adequate length of conduit
• Ensure there are no arterial gaps between the arcades - if present, choose the gap as the starting point
• Occlude vessels to be divided, checking to confirm no ischaemia results
• Ligate and divide artery 1-2cm proximal to the point where it branches into arcade