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Surgical and Radiologic Anatomy

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Open Access 01-12-2018 | Original Article

Neurovasculature of high and low tie ligation of the inferior mesenteric artery

Authors: Amy Campbell, Angus Macdonald, Raymond Oliphant, David Russell, Quentin A. Fogg

Published in: Surgical and Radiologic Anatomy | Issue 12/2018

Abstract

Purpose

Controversy exists as to whether a high or low tie ligation of the inferior mesenteric artery (IMA) is the preferred technique in surgeries of the left colon and rectum. This study aims to contribute to the discussion as to which is the more beneficial technique by investigating the neurovasculature at each site.

Methods

Ten embalmed cadaveric donors underwent division of the inferior mesenteric artery at the level of the low tie. The artery was subsequently ligated at the root to render a section of tissue for histological analysis of the proximal (high tie), mid and distal (low tie) segments.

Results

Ganglia observed in the proximal end of seven specimens in the sample imply that there would be disruption to the innervation in a high tie procedure.

Conclusion

This study suggests that a high tie should be avoided if the low tie is oncologically viable.

Bertrand MM, Delmond L, Mezars R, Ripoche J, Marcri F, Prudhomme M (2014) Is low tie ligation truly reproducible in colorectal cancer surgery? Anatomical study of the inferior mesenteric artery division branches. Surg Radiol Anat 36:1057–1062CrossRef

Boström P, Haapamäki MM, Matthiessen P, Ljung R, Rutegård J, Rutegård M (2015) High arterial ligation and risk of anastomotic leakage in anterior resection for rectal cancer in patients with increased cardiovascular risk. Colorectal Dis 17:1018–1027CrossRef

Buunen M, Lange MM, Ditzel M, Kleinrensink GJ, van de Velde CJH, Lange JF (2009) Level of arterial ligation in total mesorectal excision (TME): an anatomical study. Int J Colorectal Dis 24:1317–1320CrossRef

Candela G, Di Libero L, Varriale S, Manetta F, Giordano M, Maschino A, Argenziano G, Pizza A, Sciascia V, Napolitano S, Sanitini L (2008) Effects of high and low ligation on survival in patients operated for colorectal cancer. Chir Ital 60:75–81PubMed

Chen SC, Song XM, Chen ZH, Li MZ, He YL, Zhan WH (2010) Role of different ligation of the inferior mesenteric artery in sigmoid colon or rectal cancer surgery: a meta-analysis. Zhonghua Wei Chang Wai Ke Za Zhi 13:674–677PubMed

Cirocchi R, Trastulli S, Farinella E, Desiderio J, Vettoretto N, Parisi A, Boselli C, Noya G (2012) High tie versus low tie of the inferior mesenteric artery in colorectal cancer: a RCT is needed. Surg Oncol 21:111–123CrossRef

Fazio VW, Fletcher J, Montague D (1980) Prospective study of the effect of resection of the rectum on male sexual function. World J Surg 4:149–152CrossRef

Höer J, Roegels A, Prescher A, Klosterhalfen B, Töns C, Schumpelick V (2000) Preserving autonomic nerves in rectal surgery. Results of surgical preparation on human cadavers with fixed pelvic sections. Chirurg 71:1222–1229CrossRef

Kanemitso Y, Hirari T, Komori K, Koto T (2006) Survival benefit of high ligation of the inferior mesenteric artery in sigmoid colon or rectal cancer surgery. Br J Surg 93:609–615CrossRef

10.

Komen NAP, Slieker J, Kort P, de Wilt JHW, de Harst E, van der Coene P, Gosselink MP, Tetteroo G, Graaf EJR, de Beek T, van Toom R, den Bockel W, van Verhoef C, Lange JF (2011) High tie versus low tie in rectal surgery: comparisons of anastomotic perfusion. Int J Colorectal Dis 26:1075–1078CrossRef

11.

Lange MM, Buunen M, van de Velde CJ, Lange JF (2008) Level of arterial ligation in rectal cancer surgery: low tie preferred over high tie. A review. Dis Colon Rectum 51:112–1145CrossRef

12.

Liang JT, Huang KC, Lai HS, Lee PH, Sun CT (2007) Oncologic results of laparoscopic D3 lymphadenectomy for male sigmoid and upper rectal cancer with clinically positive lymph nodes. Ann Surg Oncol 14:1980–1990CrossRef

13.

Loftus EV, Silverstein MD, Sandborn WJ, Tremaine WJ, Harmsen WS, Zinsmeister AR (1998) Crohn’s disease in Olmsted County, Minnesota, 1940–1993 (incidence, prevalence and survival). Gastroenterology 114:1161–1168CrossRef

14.

McCowan C, Munro AJ, Donnan PT, Steele RJC (2013) Use of aspirin post-diagnosis in a cohort of patients with colorectal cancer and its association with all-cause and colorectal cancer specific mortality. Eur J Cancer 49:1049–1057CrossRef

15.

Miles WE (1971) A method of performing abdomino-perineal excision for carcinoma of the rectum and of the terminal portion of the pelvic colon 1908. CA Cancer J Clin 21:361–364CrossRef

16.

Moszkowicz D, Alsaid B, Bessede T, Penna C, Nordlinger B, Benoît G, Peschaud F (2011) Where does pelvic nerve injury occur during rectal surgery for cancer? Colorectal Dis 13:1326–1334CrossRef

17.

Moynihan B (1908) The surgical treatment of cancer of the sigmoid flexure and rectum. Surg Gynaecol Obstet 6:463–466

18.

Oliphant R, Nicholson G, Horgan P, Molloy R, McMillan D, Morrison D, In collaboration with the West of Scotland Colorectal Managed Clinical Network (2013) Contribution of surgical specialization to improved colorectal cancer survival. Br J Surg 100:1388–1395CrossRef

19.

Perricone V, Finnis D, Ward AS, Heald RJ, Moran BJ (2004) Irreversible lower limb ischemia following ligation of the inferior mesenteric artery in the surgical treatment of rectal cancer. Tech Coloproctol 8:183–184CrossRef

20.

Rutegård M, Hemmingsson O, Matthiessen P, Rutegård J (2012) High tie in anterior resection confers no increased risk of anastomotic leakage. Br J Surg 99:127–132CrossRef

21.

Sabri S, Cotton LT (1971) Sexual function following aortoilliac reconstruction. Lancet 298:1218–1219CrossRef

22.

Sato K, Inomata M, Kakisako K, Shiraishi N, Adachi Y, Kitano S (2003) Surgical technique influences bowel function after low anterior resection and sigmoid colectomy. Hepatogastroenterology 50:1381–1284

23.

Sekimoto M, Takemasa I, Mizushima T, Ikeda M, Yamamoto H, Doki Y, Mori M (2011) Laparoscopic lymph node dissection around the inferior mesenteric artery with preservation of the left colic artery. Surg Endosc 25:861–866CrossRef

24.

Titu LV, Tweedle E, Rooney PS (2008) High tie of the inferior mesenteric artery in curative surgery for left colonic and rectal cancers: a systematic review. Dig Surg 25:148–157CrossRef

25.

Tsujinaka S, Kawamura YJ, Tan KY, Mizokami K, Sasaki J, Maeda T, Kuwahara Y, Konishi F, Lefor A (2012) Proximal bowel necrosis after high ligation of the inferior mesenteric artery in colorectal surgery. Scand J Surg 101:21–25CrossRef

26.

Zhang C, Li GX, Ding ZH, Wu T, Zhong SZ (2006) Preservation of the autonomic nerve in rectal cancer surgery: anatomical factors in ligation of the inferior mesenteric artery. Nan Fang Yi Ke Da Xue Xue Bao 26:49–52PubMed

Title: Neurovasculature of high and low tie ligation of the inferior mesenteric artery
Authors: Amy Campbell
Angus Macdonald
Raymond Oliphant
David Russell
Quentin A. Fogg
Publication date: 01-12-2018
Publisher: Springer Paris
Published in: Surgical and Radiologic Anatomy / Issue 12/2018
Print ISSN: 0930-1038
Electronic ISSN: 1279-8517
DOI: https://doi.org/10.1007/s00276-018-2092-3

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Neurovasculature of high and low tie ligation of the inferior mesenteric artery

Abstract

Purpose

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

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