Level of arterial ligation in total mesorectal excision (TME): an anatomical study.
BACKGROUND
High-tie ligation is a common practice in rectal cancer surgery. However, it compromises perfusion of the proximal limb of the anastomosis. This anatomical study was designed to assess the value of low-tie ligation in order to obtain a tension-free anastomosis.


METHODS
Consecutive high- and low-tie resections were performed on 15 formalin-fixed specimens, with or without splenic flexure mobilization. If the proximal colon limb could reach the superior aspect of the symphysis pubis with more than 3 cm, the limb would be long enough for a tension-free colorectal anastomosis.


RESULTS
In 80% of cases, it was not necessary to perform high-tie ligation as sufficient length was gained with low-tie ligation. The descending branch of the left colic artery was the limiting factor in the other 20% of cases. Resecting half the sigmoid resulted in four times as many tension-free anastomoses after low-tie resection.


CONCLUSIONS
In the majority of cases, it was not necessary to perform high-tie ligation in order to create a tension-free anastomosis. Low-tie ligation was applicable in 80% of cases and might prevent anastomotic leakage due to insufficient blood supply of the proximal colon limb.
Buunen
Mark
M
Department of Surgery, Erasmus Medical Center, Room Z-835, Dr. Molewaterplein 40, 3015 GD Rotterdam, The Netherlands. m.buunen@erasmusmc.nl
Lange
Marilyne M
MM
Ditzel
Max
M
Kleinrensink
Geert-Jan
GJ
van de Velde
Cees J H
CJ
Lange
Johan F
JF
D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical; D001158:Arteries / Q000601:surgery*; D005260:Female; D006801:Humans; D008026:Ligation; D008297:Male; D008875:Middle Aged; D011630:Pubic Bone / Q000473:pathology; D012007:Rectum / Q000098:blood supply / Q000473:pathology* / Q000601:surgery*