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Preservation of the inferior mesenteric artery VS ligation of the inferior mesenteric artery in left colectomy: evaluation of functional outcomes—a prospective non-randomized controlled trial

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Abstract

Vascular approach during elective laparoscopic left colectomy impacts post-operative outcomes. The aim of our study was to evaluate how different approaches impact positively defecatory, urinary and sexual functions and quality of life during elective laparoscopic left colectomy. A prospective non-randomized controlled trial at two tertiary center was conducted. All patients who underwent elective laparoscopic left colonic resection from January 2019 to July 2022 were analyzed. They were divided into two groups based on Inferior Mesenteric Artery (IMA) preservation with distal ligation of sigmoid branches close to a colonic wall for complicated diverticular disease and IMA high tie ligation for oncological disease. Patients were asked to fulfil standardized, validated questionnaires to evaluate pre and post-operative defecatory, urinary and sexual functions and quality of life. Defecatory disorders were assessed by high-resolution anorectal manometry preoperatively and six months after surgery. A total of 122 patients were included in the study. The 62 patients with IMA preservation showed a lower incidence of defecatory disorders also confirmed by manometer data, minor incontinence and less lifestyle alteration than the 60 patients with IMA high tie ligation. No urinary disorders such as incomplete emptying, frequency, intermittence or urgency were highlighted after surgery in the IMA preservation group. Evidence of any sexual disorders remained controversial. The IMA-preserving vascular approach seems to be an effective strategy to prevent postoperative functional disorders. It is a safe and feasible technique especially for diverticular disease. New prospective randomized and highly probative studies are needed to confirm the effectiveness in specific clinical situations.

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Authors and Affiliations

  1. Department of General Surgery, SS Annunziata Hospital, 67039, Sulmona, L’Aquila, Italy

    Vania Silvestri & Emanuele Pontecorvi

  2. Department of General Surgery, Santa Maria Delle Grazie Hospital, Pozzuoli, 80078, Naples, Italy

    Antonio Sciuto & Felice Pirozzi

  3. Department of Public Health, University of Naples Federico II, 80131, Naples, Italy

    Daniela Pacella, Roberto Peltrini, Michele D’Ambra, Ruggero Lionetti, Marcello Filotico, Federica Lauria & Francesco Corcione

  4. Department of Clinical Medicine and Surgery, University of Naples Federico II, 80131, Naples, Italy

    Giovanni Sarnelli

  5. S. Giovanni-Addolorata Hospital, 00184, Rome, Italy

    Francesco Ruotolo

  6. Department of Medicine, Surgery and Dentistry, University of Salerno, 84084, Salerno, Italy

    Umberto Bracale

  7. Department of General Surgery, Clinica Mediterranea, 80122, Naples, Italy

    Francesco Corcione

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  1. Vania Silvestri
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Contributions

VS: study conception and design, analysis and interpretation of data, drafting of the manuscript, critical revision of the manuscript. EP: analysis and interpretation of data, drafting of the manuscript, critical revision of the manuscript. AS: acquisition of data, critical revision of the manuscript. DP: statistical analysis. RP: critical revision of the manuscript. MD: critical revision of the manuscript. RL: critical revision of the manuscript. MF: acquisition of data. FL: acquisition of data. GS: acquisition of data, analysis and interpretation of data. FP: critical revision of the manuscript. FR: analysis and interpretation of data. UB: study conception and design, critical revision of the manuscript. FC: study conception and design, analysis and interpretation of data, and final approval of the manuscript.

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Correspondence to Vania Silvestri.

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Conflict of interest

Drs. Vania Silvestri, Dr. Emanuele Pontecorvi, Dr. Antonio Sciuto, Drs. Daniela Pacella, Dr. Roberto Peltrini, Dr. Michele D’ambra, Dr. Ruggero Lionetti, Dr. Marcello Filotico, Drs. Federica Lauria, Dr. Giovanni Sarnelli, Dr. Felice Pirozzi, Dr. Francesco Ruotolo, Prof. Umberto Bracale and Prof. Francesco Corcione have no conflicts of interest or financial ties to disclose.

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Silvestri, V., Pontecorvi, E., Sciuto, A. et al. Preservation of the inferior mesenteric artery VS ligation of the inferior mesenteric artery in left colectomy: evaluation of functional outcomes—a prospective non-randomized controlled trial. Updates Surg 75, 1569–1578 (2023). https://doi.org/10.1007/s13304-023-01593-6

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