title: Energy vessel sealing systems versus mechanical ligature of the inferior mesenteric artery in laparoscopic sigmoidectomy.
abstract: OBJECTIVE
  With the development of new devices, our ligation technique of the inferior mesenteric artery changed from mechanical ligature (ML) to energized vessel sealing systems (EVSS) ligature. The aim of this study was to determine if EVSS could be considered as safe and effective as the more convention ML of the inferior mesenteric vessels division during elective laparoscopic left colectomy.
  
  
  METHODS
  Between 2001 and 2014, 200 consecutive patients (111 males) of mean age 54.1 years were operated laparoscopically for a symptomatic sigmoid diverticulitis. Vascular interruptions were performed using mechanical ligatures including double clipping, staples or surgical thread (100 patients) or, starting from 2006, with EVSS thereafter (100 patients). Section of the inferior mesenteric artery is performed systematically at its origin in our institution for teaching purposes. Technical results were prospectively collected perioperatively and postoperatively.
  
  
  RESULTS
  There was no mortality. Mean operating time was 253.7 and 200.7 min in the ML and EVSS groups, respectively (p < 0.001). Mean hospital stay was 10.4 and 8.1 days (p < 0.001). Thirty-day complications occurred in 31 versus 25 % of patients (p = 0.26). Leakage with peritonitis occurred in 3 patients in the ML group. Hemorrhagic events occurred in both groups (2 in ML group versus 1 in EVSS group). Limitations of the study are its retrospective design and the bias due to the comparison of two historical cohorts.
  
  
  CONCLUSIONS
  EVSS for the inferior mesenteric artery are as safe and effective as ML in elective sigmoidectomy for diverticular disease with lower operative time and hospital stay.
authors: Colorectal Unit, Department of Surgery, Michalon University Hospital, CS 10 217, 38 043, Grenoble cedex, France.|Grenoble Alpes University, UMR 5525, CNRS, TIMC-IMAG, Grenoble, France.
authors: Bertrand
authors: B
authors: Trilling
authors: Colorectal Unit, Department of Surgery, Michalon University Hospital, CS 10 217, 38 043, Grenoble cedex, France.|Visceral Surgery Department, Voiron Regional Hospital, Voiron, France.
authors: Romain
authors: R
authors: Riboud
authors: Colorectal Unit, Department of Surgery, Michalon University Hospital, CS 10 217, 38 043, Grenoble cedex, France.
authors: Julio
authors: J
authors: Abba
authors: Colorectal Unit, Department of Surgery, Michalon University Hospital, CS 10 217, 38 043, Grenoble cedex, France.|Grenoble Alpes University, UMR 5525, CNRS, TIMC-IMAG, Grenoble, France.
authors: Edouard
authors: E
authors: Girard
authors: Colorectal Unit, Department of Surgery, Michalon University Hospital, CS 10 217, 38 043, Grenoble cedex, France. JLFaucheron@chu-grenoble.fr.|Grenoble Alpes University, UMR 5525, CNRS, TIMC-IMAG, Grenoble, France. JLFaucheron@chu-grenoble.fr.
authors: Jean-Luc
authors: JL
authors: Faucheron
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001803:Blood Transfusion; D012809:Colon, Sigmoid / Q000601:surgery*; D003710:Demography; D005260:Female; D006454:Hemoglobins / Q000378:metabolism; D006801:Humans; D007430:Intraoperative Care; D010535:Laparoscopy; D008026:Ligation / Q000379:methods*; D008297:Male; D017537:Mesenteric Artery, Inferior / Q000601:surgery*; D008875:Middle Aged; D011182:Postoperative Care; D011183:Postoperative Complications / Q000209:etiology; D055815:Young Adult
chemical_list: D006454:Hemoglobins
keywords: Colectomy; Diverticulitis; Energized vessel sealing systems; Inferior mesenteric artery; Laparoscopy; Mechanical ligature