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Lan K, Yang H, Shu SL, Zhang FQ, Sun C, Yu X, Di Yue X, Lu K, Zhong FR, Tu SJ, Luo JL, Peng XF, Zeng KR. Effect of left colonic artery preservation on perfusion at the anastomosis in rectal cancer surgery evaluated with intraoperative ultrasound. Tech Coloproctol 2024; 28:157. [PMID: 39532723 PMCID: PMC11557712 DOI: 10.1007/s10151-024-03037-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2024] [Accepted: 10/13/2024] [Indexed: 11/16/2024]
Abstract
PURPOSE Intraoperative ultrasound was used to assess the flow velocity in the marginal vessel arch adjacent to the anastomosis, critical for evaluating the anastomotic blood supply. This technique also enabled us to investigate the potential effects of preserving the left colonic artery on the perfusion of the anastomosis. METHODS This prospective study included 40 rectal cancer patients who underwent laparoscopic anterior resection between January 2021 and January 2023. The length of the inferior mesenteric artery (IMA) was measured from its origin to the first branch, and the diameters of the mesenteric vessel IMA, left colonic artery (LCA), and marginal mesenteric artery (MMA) were recorded. Blood flow velocity and Doppler ultrasound waveforms of the MMA near the anastomosis were collected. Measurements were taken both before and after clamping the IMA using atraumatic forceps. The tardus parvus pattern of the MMA ultrasound waveforms was recorded to evaluate the hypoperfusion status of the anastomosis. RESULTS The mean velocities of MMA were 47.9 cm/s before clamping and 34.9 cm/s after atraumatic clamping, indicating significant differences (p < 0.05). Thirteen patients (32.5%) exhibited a Tardus parvus pattern after IMA atraumatic clamping. Multivariate analysis revealed older age and LCA diameter as independent clinical predictors of the hypoperfusion status after IMA clamping. CONCLUSIONS Preservation of the LCA may improve perfusion near the anastomosis during rectal cancer surgery. Older age and LCA diameter can be considered useful predictors of the mesenteric hypoperfusion status after IMA ligation. Intraoperative ultrasound can evaluate the perfusion of the MMA near the anastomosis. Chinese Clinical Trial Registry-Registration number: ChiCTR2000041475.
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Affiliation(s)
- Ke Lan
- Department of General Surgery, Zigong Fourth People's Hospital, Zigong, Sichuan, China
| | - Hua Yang
- Department of General Surgery, Zigong Fourth People's Hospital, Zigong, Sichuan, China
| | - Shi Long Shu
- Department of General Surgery, Zigong Fourth People's Hospital, Zigong, Sichuan, China
| | - Fa Qiang Zhang
- Department of General Surgery, Zigong Fourth People's Hospital, Zigong, Sichuan, China
| | - Chong Sun
- Department of General Surgery, Zigong Fourth People's Hospital, Zigong, Sichuan, China
| | - Xuan Yu
- Department of General Surgery, Zigong Fourth People's Hospital, Zigong, Sichuan, China
| | - Xuan Di Yue
- Department of General Surgery, Zigong Fourth People's Hospital, Zigong, Sichuan, China
| | - Kai Lu
- Department of General Surgery, Zigong Fourth People's Hospital, Zigong, Sichuan, China
| | - Fu Rui Zhong
- Department of General Surgery, Zigong Fourth People's Hospital, Zigong, Sichuan, China
| | - Sheng Jin Tu
- Department of General Surgery, Zigong Fourth People's Hospital, Zigong, Sichuan, China
| | - Jin Long Luo
- Department of General Surgery, Zigong Fourth People's Hospital, Zigong, Sichuan, China
| | - Xue Feng Peng
- Department of General Surgery, Zigong Fourth People's Hospital, Zigong, Sichuan, China
| | - Ke Rui Zeng
- Department of General Surgery, Zigong Fourth People's Hospital, Zigong, Sichuan, China.
- Zigong Fourth People's Hospital, 400 Dangui Street, Ziliujing District, Zigong, Sichuan, China.
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Colledan M, Pinelli D, Fontanella L. Surgical Complications Following Transplantation. PEDIATRIC HEPATOLOGY AND LIVER TRANSPLANTATION 2019:535-553. [DOI: 10.1007/978-3-319-96400-3_30] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2025]
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