Is inferior mesenteric artery ligation during sigmoid colectomy for diverticular disease associated with increased anastomotic leakage? A meta-analysis of randomized and non-randomized clinical trials.
OBJECTIVE
A meta-analysis was conducted to compare preservation with ligation of the inferior mesenteric artery (IMA) during sigmoidectomy for diverticular disease.


METHODS
Randomized and non-randomized clinical trials were identified using the following electronic databases: Medline, Embase, Cochrane Central Register of Controlled Trials, CINAHL, BioMed Central, Science Citation Index, Greynet, SIGLE, National Technological Information Service, British Library Integrated Catalogue. The analysed end-points were the anastomotic leakage rate, overall morbidity and 30-day postoperative mortality.


RESULTS
Four studies were included involving 400 patients. The anastomotic leakage rate was 7.3% in the preservation group and 11.3% in the ligation group. There was no statistically significant difference between the groups (OR 0.72, 95% CI 0.11-4.76; P=0.73). Overall morbidity and 30-day postoperative mortality were not compared since these data were reported in only one study.


CONCLUSIONS
The meta-analysis did not show any advantage for preservation of the IMA during sigmoid colectomy for diverticular disease in terms of anastomotic leakage.
Department of General Surgery, University of Perugia, St Maria Hospital, Terni, Italy.
R
R
Cirocchi
S
S
Trastulli
E
E
Farinella
J
J
Desiderio
C
C
Listorti
A
A
Parisi
G
G
Noya
C
C
Boselli
D057868:Anastomotic Leak / Q000209:etiology*; D003082:Colectomy / Q000009:adverse effects / Q000379:methods*; D004239:Diverticulitis, Colonic / Q000601:surgery*; D006801:Humans; D008026:Ligation / Q000009:adverse effects / Q000379:methods; D017537:Mesenteric Artery, Inferior / Q000601:surgery*; D012810:Sigmoid Diseases / Q000601:surgery*