Level of arterial ligation in total mesorectal excision TME: an anatomical studyReport as inadecuate




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International Journal of Colorectal Disease

, 24:1317

First Online: 16 July 2009Accepted: 23 June 2009

Abstract

IntroductionHigh-tie ligation is a common practice in rectal cancer surgery. However, it compromises perfusion of the proximal limb of the anastomosis. This anatomical study was designed to assess the value of low-tie ligation in order to obtain a tension-free anastomosis.

Materials and methodsConsecutive high- and low-tie resections were performed on 15 formalin-fixed specimens, with or without splenic flexure mobilization. If the proximal colon limb could reach the superior aspect of the symphysis pubis with more than 3 cm, the limb would be long enough for a tension-free colorectal anastomosis.

ResultsIn 80% of cases, it was not necessary to perform high-tie ligation as sufficient length was gained with low-tie ligation. The descending branch of the left colic artery was the limiting factor in the other 20% of cases. Resecting half the sigmoid resulted in four times as many tension-free anastomoses after low-tie resection.

ConclusionIn the majority of cases, it was not necessary to perform high-tie ligation in order to create a tension-free anastomosis. Low-tie ligation was applicable in 80% of cases and might prevent anastomotic leakage due to insufficient blood supply of the proximal colon limb.

KeywordsVascular anatomy Anastomosis Inferior mesenteric artery Rectal cancer  Download fulltext PDF



Author: Mark Buunen - Marilyne M. Lange - Max Ditzel - Geert-Jan Kleinrensink - Cees J. H. van de Velde - Johan F. Lange

Source: https://link.springer.com/article/10.1007/s00384-009-0761-8







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