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Techniques in Coloproctology

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01-03-2019 | Rectal Cancer | Short Communication

Level of inferior mesenteric artery ligation in low rectal cancer surgery: high tie preferred over low tie

Authors: E. Girard, B. Trilling, P.-Y. Rabattu, P.-Y. Sage, N. Taton, Y. Robert, P. Chaffanjon, J.-L. Faucheron

Published in: Techniques in Coloproctology | Issue 3/2019

Abstract

Background

There is no demonstrated benefit of high-tie versus low-tie vascular transections in low rectal cancer surgery. The aim of this study was to compare the effects of high tie and low tie of the inferior mesenteric artery on colonic length.

Methods

This study was conducted in a surgical anatomy research laboratory. Anatomical dissections were performed on 11 human cadavers. We performed full left colonic mobilization, section of the descending-sigmoid junction, and high and low ligation of the inferior mesenteric artery. Distance from the proximal colon limb to the lower edge of the pubis symphysis was recorded after each step of vascular division. Three measurements were successively performed: before vascular section, after inferior mesenteric artery ligation, and after inferior mesenteric artery and vein section.

Results

Before vascular section, the mean distance between colonic end and lower edge of the symphysis pubis was − 1.9 ± 3.5 cm. After combined artery and vein section, the mean distance was + 10.7 ± 4.6 cm for high tie and + 1.5 ± 3 cm for low tie. A limitation of this study is the use of embalmed anatomical specimens, rather than live patients, and the small number of specimens. This study also does not evaluate colon limb vascularization or the impact of proximal lymph node dissection on survival rates.

Conclusions

High tie of the inferior mesenteric artery at its aortic origin allows a gain of extra length of about 9 cm over low tie.

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Title: Level of inferior mesenteric artery ligation in low rectal cancer surgery: high tie preferred over low tie
Authors: E. Girard
B. Trilling
P.-Y. Rabattu
P.-Y. Sage
N. Taton
Y. Robert
P. Chaffanjon
J.-L. Faucheron
Publication date: 01-03-2019
Publisher: Springer International Publishing
Keywords: Rectal Cancer
Rectal Cancer
Published in: Techniques in Coloproctology / Issue 3/2019
Print ISSN: 1123-6337
Electronic ISSN: 1128-045X
DOI: https://doi.org/10.1007/s10151-019-01931-0

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Level of inferior mesenteric artery ligation in low rectal cancer surgery: high tie preferred over low tie

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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