Ratchamon Pinyoteppratarn, MD, Siripong Sirikurnpiboon, MD, Kasidin Vitoopinyoparb, MD, Bunlung Muyphuag, MD, Thawee Ratanachu-ek, MD. Rajavithi Hospital
Introduction In curatively intended resection of sigmoid cancer, ligation of the root of the inferior mesenteric artery (IMA), high tie, is considered necessary for wide lymph node dissection. IMA ligation compromises blood ?ow to the anastomosis and may damage to the autonomic nerve nearby, which may increase the leakage rate and cause postoperative impaired anorectal function. Accordingly, some surgeons employ a technique of preserving the IMA for increase blood flow and decrease postoperative bowel complications. But these technique was reported to need longer time in laparoscopic surgery due to technical dif?culties and the adequate of lymph nodes clearance and benefits in postoperative anorectal function are unclear. This study aim to compare the operative results of two methods in laparoscopic sigmoid colectomy (with or without preservation of the IMA) in term of operative time, blood loss, lymph nodes clearance, complications, postoperative anorectal function and recurrence rate.
Methods & Procedures A 1:2 Case-matched comparative study were applied and retrospectively analysed 27 patients (19 female and 8 male, mean age 63 ± 9.44years) with sigmoid tumor, who underwent surgery between January2012 and December 2015. Laparoscopic sigmoid colectomy with preservation of the IMA was performed in 9 patients, and ligation of the IMA with sigmoidectomy was carried out in 18 patients. Bowel function follow-up was performed at 6 and 12 months after surgery.
Results Lymph nodes around the IMA were dissected with preservation of the IMA in 9 cases (group A). And the IMA was ligated in 18 cases (group B). Mean operative time was 194.44(+28.77), 178.89 (+55.52)min for group A and B,(P=0.349) ,Respective blood loss 94.44(+52.71), 79.44 (+58.15) ,(P=0.51)and mean numbers of harvested LN were 14.56(+3.74) and 17.56 (+7.64),( P=0.183). Three patients of the IMA-ligated group had a short period of stool frequency (2-4 weeks postoperative) and one with constipation. No leakage, bleeding or recurrent tumor were found in both group. None of the operative results of groups A and B were different statistically.
Conclusions Laparoscopic sigmoid colectomy with preservation of the IMA in 9 cases allows equivalent laparoscopic lymph node dissection to the high tie technique without excessive operative time or bleeding and may lower the frequency of postoperative impaired anorectal function.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 79292
Program Number: S156
Presentation Session: Minimally Invasive Surgery – World Tour
Presentation Type: Podium