High Ligation of the Inferior Mesenteric Artery Induces Hypoperfusion of the Sigmoid Colon Stump During Anterior Resection

Figures

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  Figure 1. Intraoperative images of (A) ileocecal resection and (B) anterior rectal resection.

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  Figure 2. Blood flow of the bowel stumps during ICR or AR. The FT of the ileal and ascending colon stumps during ICR was 33.5 ± 8.1 s and 33.7 ± 8.2 s, respectively (p = 1.000). The FT of the sigmoid colon and rectal stumps during AR was 41.8 ± 9.1 s and 45.8 ± 9.3 s, respectively (p = 0.642). The FTs during AR (of both the sigmoid colon and rectal stumps) were significantly longer than the FTs during ICR (of both the ascending colon and ileal stumps: sigmoid colon vs. ascending colon, p = 0.001; sigmoid colon vs. ileum, p = 0.001; rectum vs. ascending colon, p = 0.003; rectum vs. ileum, p = 0.003). ICR: ileocecal resection; AR: anterior rectal resection; FT: fluorescence time (time from indocyanine green injection and injection route flush to the time at which the strongest fluorescent signal was observed in the stump).

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  Figure 3. Effect of the level of ligation of the main artery on the blood flow of the bowel stumps during surgery. (A) Effect of the level of ligation of the ICA during ICR. HL of the ICA did not affect the FT of the ileal or ascending colon stumps (p = 0.860 and p = 0.934, respectively). (B) Effect of the level of ligation of the IMA during AR. HL of the IMA significantly prolonged the FT of the sigmoid colon (p = 0.004). All patients with a measurable rectal stump blood flow received HL of the IMA. ICA, ileocecal artery; ICR, ileocecal resection; HL, high ligation; FT, fluorescence time (time from indocyanine green injection and injection route flush to the time at which the strongest fluorescent signal was observed in the stump); IMA, inferior mesenteric artery; AR, anterior rectal resection; LL, low ligation.

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  Figure 4. (A,B) Association between anastomotic leakage in anterior rectal resection and surgery type. L-IMA, low ligation of the IMA; H-IMA, high ligation of the IMA; LAL, low anterior rectal resection; HAR, high anterior rectal resection. Calculated by Fisher's exact 2 × 2 contingency table.

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  Figure 5. Blood flow and anastomotic leakage in ICR vs AR. (A) Comparison of the FT between the ascending and sigmoid colon with preservation of the left colic artery. The FT of the sigmoid colon with LL of the IMA (34.7 ± 8.5 s) is similar to the FT of the ascending colon with HL or LL of the ICA (33.9 ± 9.9 s and 33.4 ± 6.3 s, respectively) (p = 0.932). (B) Association between AL and surgery type. The occurrence of AL in LAL did not represent a significant difference vs. ICR (p = 0.071). Calculated by Fisher's exact 2 × 2 contingency table. HL, high ligation; LL, low ligation; ICR, ileocecal resection; LAL, low anterior rectal resection.