Preservation of the inferior mesenteric artery VS ligation of the inferior mesenteric artery in left colectomy: evaluation of functional outcomes-a prospective non-randomized controlled trial

The left colic artery: a comprehensive analysis

The anatomy of the left colic artery (LCA) is subject to a considerable level of variability, both in its origin, branching pattern, and location in the abdominal cavity. Due to this variability, many studies have tried to describe the vascular anatomy of this anatomical entity using various classifications. It is hoped that the results of the present study may aid surgeons in increasing their anatomical knowledge relevant to colorectal surgeries. A retrospective analysis, including 75 consecutive patients, was conducted to assess the anatomical and morphometric variations of the LCA. Finally, a total of 67 LCAs were included in this study. The majority of the LCA originated directly (N = 48; 71.64%) or indirectly via the colo-sigmoid trunk (N = 18; 26.87%) from the inferior mesenteric artery (IMA). The most common variation of the LCA, according to the Yada, or analogical Wang, classification, was found to be Type I (N = 28; 50.00%). The median diameter of the LCA at its origin was found to be 2.12 mm (LQ = 1.77; HQ = 2.51). The median cross-sectional area of the LCA at its origin was set to be 3.38 mm2 (LQ = 2.29; HQ = 4.33). In conclusion, this study provides a detailed analysis of the anatomical and morphometric variations of the LCA, offering valuable insights for improving the safety and effectiveness of colorectal surgeries, particularly during procedures involving ligation of the IMA. These results emphasize the need for thorough preoperative imaging and anatomical understanding to minimize the risk of iatrogenic injury. Preserving the LCA during low ligation of the IMA is shown to be crucial for maintaining adequate blood supply to the remaining bowel, reducing the risk of ischemia, and ensuring better patient outcomes.

Inferior mesenteric artery preservation techniques in the treatment of diverticular disease: a systematic review of the literature

PURPOSE

The aim of this study is to analyze the impact of different surgical techniques used to preserve the inferior mesenteric artery on patient outcomes following left colonic resection.

METHODS

A search was conducted in PubMed, Embase and Web of Science, founding 4795 articles. The review was registered on PROSPERO (registration number: CRD42024572291).

RESULTS

Eleven articles published between 2001 and 2023, including 989 patients were the object of the present systematic review. Two hundred sixty-two patients (26.5%) underwent Valdoni's technique (Group A), which involves the skeletonization of the IMA, 272 (27.5%) underwent tubular resection (Group B), and 455 (46%) underwent peripheral dissection on sigmoid vessels (Group C). Laparoscopic surgery was predominant in Groups B (100%) and C (94.7%), while Group A had fewer laparoscopic procedures (44.6%). Patients in Group A experienced longer operative times (174.5 ± 27.4 min) and hospital stays (11.4 ± 3.6 days) compared to Groups B and C (165.9 min and 152.35 ± 46.9 min; 8.4 ± 5.7 days and 8.3 ± 3.6 days, respectively). Group A exhibited higher rates of anastomotic leakage (5%) compared to Group C (1.1%) and a higher incidence of bleeding (13%) compared to Group B (1.8%).

CONCLUSION

Valdoni's technique is less favourable for IMA preservation in left colon resection for diverticular disease. Peripheral dissection of sigmoid vessels or tubular resection is recommended for IMA preservation in this context.

Totally laparoscopic management of a giant sigmoid colon diverticulum: Case report and review of literature

The giant diverticulum of the sigmoid colon is a rare clinical condition characterized by a high risk of complications. Its etiology is multifactorial, with longstanding diverticular disease and motor dysfunction of the colon as risk factors. Even though its diagnosis could be challenging, clinicians can rely on barium enemas revealing the characteristic findings of a large, air-filled sac adjacent to the colon on a computed tomography scan and colonoscopy. The use of these tools aids in ruling out alternative diagnoses and confirming the presence of a diverticulum. Timely surgical management is essential, also in asymptomatic fit-for-surgery patients, to prevent potential complications.

The Atlas of the Inferior Mesenteric Artery and Vein under Maximum-Intensity Projection and Three-Dimensional Reconstruction View

(1) Background: Understanding vascular patterns is crucial for minimizing bleeding and operating time in colorectal surgeries. This study aimed to develop an anatomical atlas of the inferior mesenteric artery (IMA) and vein (IMV). (2) Methods: A total of 521 patients with left-sided colorectal cancer were included. IMA and IMV patterns were identified using maximum-intensity projection (MIP) and three-dimensional (3D) reconstruction techniques. The accuracy of these techniques was assessed by comparing them with surgical videos. We compared the amount of bleeding and operating time for IMA ligation across different IMA types. (3) Results: Most patients (45.7%) were classified as type I IMA, followed by type II (20.7%), type III (22.6%), and type IV (3.5%). Newly identified type V and type VI patterns were found in 6.5% and 1% of patients, respectively. Of the IMVs, 49.9% drained into the superior mesenteric vein (SMV), 38.4% drained into the splenic vein (SPV), 9.4% drained into the SMV-SPV junction, and only 2.3% drained into the first jejunal vein (J1V). Above the root of the left colic artery (LCA), 13.1% of IMVs had no branches, 50.1% had one, 30.1% had two, and 6.7% had three or more branches. Two patients had two main IMV branches, and ten had IMVs at the edge of the mesocolon with small branches. At the IMA root, 37.2% of LCAs overlapped with the IMV, with 34.0% being lateral, 16.9% distal, 8.7% medial, and both the marginal type of IMV and the persistent descending mesocolon (PDM) type represented 1.4%. MIP had an accuracy of 98.43%, and 3D reconstruction had an accuracy of 100%. Blood loss and operating time were significantly higher in the complex group compared to the simple group for IMA ligation (p < 0.001). (4) Conclusions: A comprehensive anatomical atlas of the IMA and IMV was provided. Complex IMA patterns were associated with increased bleeding and operating time.