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High Versus Low Inferior Mesenteric Artery Ligation in Rectal Cancer Surgery. A Retrospective Analysis and Review of the Literature

Ivan Semerdzhiev, Bozhidar Nametkov, Deyan Lazarov, Mihail Tabakov, Ersin Hodzhadzhikov, Dimitar Andonov, Antonii Filipov

Abstract

Introduction: Colorectal cancer is the leading cause for cancer-related mortality in both sexes worldwide. Around 30% of all colorectal cancers are situated in the rectum. They have worse clinical outcomes. Laparoscopic total mesorectal excision (TME), described first by Heald et al. in 1982, is a gold standard of treatment for rectal cancer. During the procedure the inferior mesenteric artery (IMA) should be ligated. However, whether high or low, the ligation is still controversial.

Aim: The aim of this article is to investigate the advantages and disadvantages of both low and high IMA ligation during laparoscopic TME for rectal cancer treatment.

Materials and Methods: We conducted a retrospective study of 77 patients operated in our department for a period of 1 year, between January 2021 and January 2022. We gathered data for gender, hospital stay, pathology findings, and perioperative complications, including anastomotic leakage, anastomotic stricture, genitourinary dysfunction, survival. We conducted a literature review and compared the results with our own experience.

Results: We performed laparoscopic TME with high IMA ligation in 53 men and 24 women. The mean operative time was 270 min. The mean hospital stay was 5 days. During the period we detected anastomotic leakage in 2 patients and no strictures of the anastomosis were identified 30 days after the procedure.

Conclusion: High IMA ligation is a safe and effective enough operative technique in rectal cancer treatment, which, when properly performed, does not lead to more perioperative complications than low IMA ligation, except for some anatomically related reasons.


Keywords

Inferior mesenteric artery, ligation, rectal cancer

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DOI: http://dx.doi.org/10.14748/ssm.v55i0.9254
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About The Authors

Ivan Semerdzhiev
Clinic of Endoscopic Surgery, St Ivan Rilski University Hospital, Sofia, Bulgaria

Bozhidar Nametkov
Clinic of Endoscopic Surgery, St Ivan Rilski University Hospital, Sofia, Bulgaria

Deyan Lazarov
Clinic of Endoscopic Surgery, St Ivan Rilski University Hospital, Sofia, Bulgaria

Mihail Tabakov
Clinic of Endoscopic Surgery, St Ivan Rilski University Hospital, Sofia, Bulgaria

Ersin Hodzhadzhikov
Clinic of Endoscopic Surgery, St Ivan Rilski University Hospital, Sofia, Bulgaria

Dimitar Andonov
Clinic of Endoscopic Surgery, St Ivan Rilski University Hospital, Sofia, Bulgaria

Antonii Filipov
Clinic of Endoscopic Surgery, St Ivan Rilski University Hospital, Sofia, Bulgaria

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