High ligation of the inferior mesenteric artery versus low ligation with high dissection of the lymph nodes at the inferior mesenteric artery root in anterior resection | ||
| The Egyptian Journal of Surgery | ||
| Volume 44, Issue 4, October 2025, Pages 1161-1168 PDF (390.75 K) | ||
| Document Type: Original Article | ||
| DOI: 10.21608/ejsur.2025.362108.1401 | ||
| Authors | ||
| Ahmed Hany* 1; Hanna Habib Hanna2; Yasser Mohamed Abdel Samei2; Mohamed Abdwahed2 | ||
| 1Department of General Surgery, Colorectal unit, Faculty of Medicine, Ain Shams University, Egypt. | ||
| 2Department of General Surgery, Colorectal Unit, Faculty of Medicine, Ain Shams University, Egypt. | ||
| Abstract | ||
| Introduction : When performing anterior resection, there are two methods for ligating the inferior mesenteric artery : low ligation, in which the surgeon ligates the inferior mesenteric artery while leaving the left colic artery intact, and high ligation, in which the surgeon ligates the inferior mesenteric artery about one centimetre from its origin. Theoretically, the removal of the left colic artery by high ligation of the inferior mesenteric artery jeopardizes the anastomosis's blood supply, which increases the possibility of anastomotic leakage. In contrast, surgeons believe that high ligation increases lymph node yield. It is proposed that the combination of low ligation of the inferior mesenteric artery and elevated dissection of lymph nodes at the root of inferior mesenteric artery may retain the left colon's blood supply and autonomic functions while increasing lymph node clearance. Patients and Methods: At the Ain-Shams University Hospitals, a prospective randomized comparative research was conducted. It comprised 40 patients in each of the two groups that had laparoscopic anterior resection for sigmoid and rectal tumors. Low inferior mesenteric artery ligation with high lymph node dissection was performed on one group, whereas high inferior mesenteric artery ligation was performed on the other. Results: Intraoperative findings indicated a shorter operation time for the high ligation group, whereas postoperative outcomes favored the low ligation group, including shorter hospital stays, faster bowel recovery, and lower rates of sexual and urinary dysfunction. The distinction in anastomotic leakage rates was not statistically significant. Conclusion: Low ligation with high dissection has clear benefits over high dissection in prevention of autonomic dysfunction, despite having a lower lymph node yield and a longer operation time. | ||
| Keywords | ||
| Anterior resection; autonomic dysfunction; high ligation; low ligation | ||
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