title: Lengthening of left colon after rectal resection: What all is adequate? A prospective cohort study.
abstract: BACKGROUND
  Adequate mobilization of colon is essential to achieve tension free anastomosis after sphinchter saving surgeries.
  
  
  METHODS
  26 patients undergoing of recto-sigmoid resection underwent low tie of inferior mesenteric artery (IMA), splenic flexure mobilization and descending branch of left colic artery (LCA) ligation in that order. One point at proximal 1/3rd of sigmoid colon (point of partial sigmoid resection) and another at descending-sigmoid colon junction (point of total sigmoid resection) were used for measurements and the distance was measured from pubic symphysis. Mobilization was considered adequate if colon could reach 2 cm beyond the upper border of pubic symphysis.
  
  
  RESULTS
  The length gained after each maneuver was 4.2 + 3.6 cm (low tie), 5.8 + 3.7 cm (splenic flexure mobilization) and 4.7 + 4.2 cm (descending branch of LCA ligation). Mobilization was adequate in 19% and 0% (low tie), 56% and 20% (low tie with splenic flexure mobilization) and 100% and 86% (all three manoeuvres) with partial and complete sigmoid resection respectively. In 13 patients undergoing low anterior resection, adequate mobilization for anastomosis was attainable in 15.3% and 0% (low tie), 50% and 0% (low tie with splenic flexure mobilization) and 100% and 83.3% (all three manoeuvres) with partial and complete sigmoid resection respectively. 15.3% had anastomotic leak, however none of the patients undergoing descending branch of LCA ligation had anastomotic insufficiency.
  
  
  CONCLUSIONS
  Low tie of IMA, with splenic flexure mobilization as required results in sufficient mobilization only in 50% patients with partial sigmoid resection. Ligation of descending branch of LCA is feasible, safe and enables a tension free anastomosis and is especially beneficial when sigmoid colon is resected completely.
authors.affiliation: Department of General Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
authors.forename: Shruthi H S
authors.initials: SH
authors.lastname: Reddy
authors.affiliation: Department of General Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India. Electronic address: vikaspgi@gmail.com.
authors.forename: Vikas
authors.initials: V
authors.lastname: Gupta
authors.affiliation: Department of General Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
authors.forename: Thakur D
authors.initials: TD
authors.lastname: Yadav
authors.affiliation: Department of General Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
authors.forename: Gurpreet
authors.initials: G
authors.lastname: Singh
authors.affiliation: Department of Anatomy, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
authors.forename: Daisy
authors.initials: D
authors.lastname: Sahni
mesh_terms: D000328:Adult; D000714:Anastomosis, Surgical / Q000009:adverse effects / Q000379:methods*; D057868:Anastomotic Leak / Q000209:etiology* / Q000601:surgery; D003082:Colectomy / Q000379:methods*; D003106:Colon / Q000098:blood supply / Q000601:surgery; D003108:Colonic Diseases / Q000601:surgery*; D005260:Female; D006801:Humans; D008026:Ligation; D008297:Male; D017537:Mesenteric Artery, Inferior / Q000601:surgery; D008875:Middle Aged; D011446:Prospective Studies; D012002:Rectal Diseases / Q000601:surgery*; D012007:Rectum / Q000098:blood supply / Q000601:surgery*
keywords: Anastomosis; Cancer; Carcinoma; Colon; Mobilization; Rectum; Technique; Tension