title: High tie versus low tie vascular ligation of the inferior mesenteric artery in colorectal cancer surgery: impact on the gain in colon length and implications on the feasibility of anastomoses.
abstract: BACKGROUND
  There is no demonstrated benefit of high-tie versus low-tie vascular transections in colorectal cancer surgery.
  
  
  OBJECTIVE
  The aim of this study was to compare the effects of high-tie and low-tie vascular transections on colonic length after oncological sigmoidectomy, the theoretical feasibility of colorectal anastomosis at the sacral promontory, and straight or J-pouch coloanal anastomosis after rectal cancer surgery with total mesorectal excision.
  
  
  METHODS
  This study is an anatomical study on surgical techniques.
  
  
  METHODS
  This study was conducted in a surgical anatomy research unit.
  
  
  METHODS
  Thirty fresh nonembalmed cadavers were randomly assigned to high-tie and low-tie groups (n = 15).
  
  
  METHODS
  Oncological sigmoidectomy followed by total mesorectal excision was performed.
  
  
  METHODS
  The distances from the proximal colon limb to the lower edge of the pubis symphysis were recorded after each step of vascular division.
  
  
  RESULTS
  The successive mean gains in length in high-tie vs low-tie vascular transections were 2.9±1.2 cm vs 3.1 ± 1.8 cm (p = 0.83) after inferior mesenteric artery division, 8.1 ± 3.1 cm vs 2.5 ± 1.2 cm (p = 0.0016) after inferior mesenteric vein division at the lower part of the pancreas, 8.1 ± 3.8 cm vs 3.3 ± 1.7 cm (p = 0.0016) after sigmoidectomy. The mean cumulative gain in length was significantly higher in high-tie vs low-tie vascular transections (19.1 ± 3.8 vs 8.8 ± 2.9 cm, p = 0.00089). After secondary left colic artery division, the gain in length was similar to that of the high-tie group (17 ± 3.1 vs 19.1 ± 3.8 cm) (p = 0.089). Colorectal anastomosis at the promontory and straight and J-pouch coloanal anastomosis feasibility rates were 100% in the high-tie group, 87%, 53%, and 33% in the low-tie group, but 100%, 100%, and 87% after secondary left colic artery division.
  
  
  CONCLUSIONS
  This anatomical study, based on cadavers rather than live patients, does not evaluate colon limb vascularization.
  
  
  CONCLUSIONS
  The gain in colonic length is 10 cm greater for high-tie vascular transections. With low-tie vascular transections, high inferior mesenteric vein division produced a small additional gain in length, and secondary left colic artery division produced the same length gain as high-tie vascular transections.
authors.affiliation: URDIA Anatomie (EA4465), Paris Descartes Faculty of Medicine, Paris, France.
authors.forename: S
authors.initials: S
authors.lastname: Bonnet
authors.forename: A
authors.initials: A
authors.lastname: Berger
authors.forename: N
authors.initials: N
authors.lastname: Hentati
authors.forename: B
authors.initials: B
authors.lastname: Abid
authors.forename: J-M
authors.initials: JM
authors.lastname: Chevallier
authors.forename: P
authors.initials: P
authors.lastname: Wind
authors.forename: V
authors.initials: V
authors.lastname: Delmas
authors.forename: R
authors.initials: R
authors.lastname: Douard
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical / Q000379:methods; D002102:Cadaver; D012809:Colon, Sigmoid / Q000098:blood supply* / Q000601:surgery; D015179:Colorectal Neoplasms / Q000098:blood supply / Q000175:diagnosis / Q000601:surgery*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007813:Laparotomy; D008026:Ligation / Q000379:methods; D008297:Male; D017537:Mesenteric Artery, Inferior / Q000601:surgery*; D016737:Proctocolectomy, Restorative / Q000379:methods*; D012007:Rectum / Q000098:blood supply* / Q000601:surgery; D016896:Treatment Outcome