Management of intraoperative complications during laparoscopic right colectomy

Impact of double-bolus tracking to individualize scan timing of the portal venous phase in preoperative computed tomography colonography angiography for right-sided colon cancer

AIM

In computed tomography colonography angiography (CTC-A), used for preoperative screening of right-sided colon cancer, the timing of venous phase imaging is conventionally determined by a fixed-delay time; however, the contrast effect may be insufficient because of individual differences in blood flow status. Therefore, we developed the double-bolus tracking (DBT) method to solve this issue.

METHOD

We compared the contrast effect and image quality of the portal venous systems between two methods of the conventional fixed-delay and DBT which utilizes low-dose monitoring to individualize venous scan timings. Data from 30 consecutive patients who underwent CTC-A for right-sided colon cancer using the DBT method were prospectively collected and compared with that from 30 consecutive patients who underwent the conventional fixed-delay method between August 2018 and July 2022. CT values of the portal vein, gastrocolic trunk, and middle colic veins were measured. Additionally, two gastrointestinal surgeons performed a five-point visual evaluation of the three-dimensional volume rendering image of the gastrocolic trunk.

RESULTS

CT values in the DBT group were significantly higher than those in the fixed-delay group. (portal vein: 266.7 HU vs. 210.0 HU; p <  0.001, gastrocolic trunk: 251.6 HU vs. 191.0 HU; p <  0.001, middle colic vein: 257.2 HU vs. 190.1 HU; p <  0.001). Visual assessment of the gastrocolic trunk was significantly higher in the DBT group than that in the fixed-delay group (DBT, 3.6, 3.4; fixed-delay, 2.6, 2.8; p =  0.003, p =  0.044).

CONCLUSION

The DBT method can enhance the contrast effect of the portal venous systems and improve image quality.

The value of mesenteric closure after laparoscopic right hemicolectomy: a scoping review

OBJECTIVE

To evaluate the prognostic impact and describe suturing tools of mesenteric closure after laparoscopic right hemicolectomy (LRH).

METHODS

PubMed, Embase, Cochrane library, Web of Science, and Scopus databases, were searched and publications relating to mesenteric closure data and tools were extracted. Search terms: "Mesenteric Defects" and "Mesenteric Closure" were used, and manual searches of eligible articles from literature reference lists performed.

RESULT

A total of 7 publications were identified. 5 focused on prognostic impact and 4 referred to tools for mesenteric closure, two of which concerned both prognostic data and tools. All studies related to prognostic impact were single center with "low" modified GRADE quality. A high degree of heterogeneous was found.

CONCLUSION

The evidence from current research does not support routine closure of mesenteric defects. Use of a polymer ligation clip has produced favorable results in a small sample size trial and further investigation is merited. A large randomized controlled trial is still warranted.