Document Detail

High tie versus low tie vascular ligation of the inferior mesenteric artery in colorectal cancer surgery: impact on the gain in colon length and implications on the feasibility of anastomoses.
MedLine Citation:
PMID:  22513429     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: There is no demonstrated benefit of high-tie versus low-tie vascular transections in colorectal cancer surgery.
OBJECTIVE: The aim of this study was to compare the effects of high-tie and low-tie vascular transections on colonic length after oncological sigmoidectomy, the theoretical feasibility of colorectal anastomosis at the sacral promontory, and straight or J-pouch coloanal anastomosis after rectal cancer surgery with total mesorectal excision.
DESIGN: This study is an anatomical study on surgical techniques.
SETTINGS: This study was conducted in a surgical anatomy research unit.
PATIENTS: Thirty fresh nonembalmed cadavers were randomly assigned to high-tie and low-tie groups (n = 15).
INTERVENTIONS: Oncological sigmoidectomy followed by total mesorectal excision was performed.
MAIN OUTCOME MEASURES: The distances from the proximal colon limb to the lower edge of the pubis symphysis were recorded after each step of vascular division.
RESULTS: The successive mean gains in length in high-tie vs low-tie vascular transections were 2.9±1.2 cm vs 3.1 ± 1.8 cm (p = 0.83) after inferior mesenteric artery division, 8.1 ± 3.1 cm vs 2.5 ± 1.2 cm (p = 0.0016) after inferior mesenteric vein division at the lower part of the pancreas, 8.1 ± 3.8 cm vs 3.3 ± 1.7 cm (p = 0.0016) after sigmoidectomy. The mean cumulative gain in length was significantly higher in high-tie vs low-tie vascular transections (19.1 ± 3.8 vs 8.8 ± 2.9 cm, p = 0.00089). After secondary left colic artery division, the gain in length was similar to that of the high-tie group (17 ± 3.1 vs 19.1 ± 3.8 cm) (p = 0.089). Colorectal anastomosis at the promontory and straight and J-pouch coloanal anastomosis feasibility rates were 100% in the high-tie group, 87%, 53%, and 33% in the low-tie group, but 100%, 100%, and 87% after secondary left colic artery division.
LIMITATIONS: This anatomical study, based on cadavers rather than live patients, does not evaluate colon limb vascularization.
CONCLUSIONS: The gain in colonic length is 10 cm greater for high-tie vascular transections. With low-tie vascular transections, high inferior mesenteric vein division produced a small additional gain in length, and secondary left colic artery division produced the same length gain as high-tie vascular transections.
S Bonnet; A Berger; N Hentati; B Abid; J-M Chevallier; P Wind; V Delmas; R Douard
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Publication Detail:
Type:  Comparative Study; Journal Article; Randomized Controlled Trial    
Journal Detail:
Title:  Diseases of the colon and rectum     Volume:  55     ISSN:  1530-0358     ISO Abbreviation:  Dis. Colon Rectum     Publication Date:  2012 May 
Date Detail:
Created Date:  2012-04-19     Completed Date:  2012-07-10     Revised Date:  2012-12-31    
Medline Journal Info:
Nlm Unique ID:  0372764     Medline TA:  Dis Colon Rectum     Country:  United States    
Other Details:
Languages:  eng     Pagination:  515-21     Citation Subset:  IM    
URDIA Anatomie (EA4465), Paris Descartes Faculty of Medicine, Paris, France.
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MeSH Terms
Aged, 80 and over
Anastomosis, Surgical / methods
Colon, Sigmoid / blood supply*,  surgery
Colorectal Neoplasms / blood supply,  diagnosis,  surgery*
Feasibility Studies
Ligation / methods
Mesenteric Artery, Inferior / surgery*
Proctocolectomy, Restorative / methods*
Rectum / blood supply*,  surgery
Treatment Outcome
Comment In:
Dis Colon Rectum. 2012 Dec;55(12):e381; author reply e381-2   [PMID:  23135594 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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