How I do itPreservation of the inferior mesenteric artery in colorectal resection for complicated diverticular disease
Section snippets
Patients
Between 1982 and 1996, 163 consecutive patients with sigmoid obstruction secondary to diverticulitis were referred for treatment to the Department of Surgery of the University of Cagliari Medical School, to the Department of Surgery and General Thoracic Surgery of the University of Perugia Medical School, or to the 1st Department of Surgery of the University of Rome “La Sapienza” Medical School. Patients with recurrent episodes of inflammation, chronic stricture, and intractable symptoms were
Surgical technique
On entry into the abdomen, blunt dissection of the developmental adhesion between the greater omentum and transverse colon was carried out; the sigmoid, descending colon, splenic flexure, and related mesentery were extensively mobilized. Splenic flexure was mobilized, transverse mesocolon was detached from the inferior pancreatic margin, and then the inferior mesenteric vein doubly ligated and sectioned at its confluence with the splenic trunk.
Patients
Data from the two groups were shown to be homogeneous for sex, age, clinical condition, comorbidity, and timing of presentation (Table 1).
Surgery
The mean surgical time was 158 ± 13.2 minutes in group A and 155 ± 15.8 minutes in group B (P = 0.7). Anastomoses were performed at rectosigmoid junction in all cases. The mean number of transfused blood units was 1.1 ± 0.4 in group A and 1.2 ± 0.5 in group B (P = 0.9).
Early outcome
The mean length of hospital stay was 13.4 ± 2.8 days in group A and 13.6 ± 3.4 days in
Comments
Tension at the anastomotic level, septic contamination of the operative field, structural and ischemic alterations of the anastomotic stumps, and technical flaws are the most important factors affecting the primary healing of intestinal anastomoses [18], [19], [20]. In the current series, in addition to the usual requirements, further technical measures were adopted specifically to enhance the safety of the anastomosis. Coloepiploic detachment has been preferred to the more generally adopted
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