title: Iatrogenic superior mesenteric vein injury: the perils of high ligation.
abstract: OBJECTIVE
  The purpose of this review is to highlight the perils and pitfalls associated with high vascular ligation during right colectomies for adenocarcinoma and to identify the various mechanisms of injury to the superior mesenteric vein (SMV) and its tributaries.
  
  
  METHODS
  This is a retrospective chart review of 304 right colectomies (159 open and 145 laparoscopic) performed over a period of 10 years (1 June 2006-31 May 2016) for right-sided colonic adenocarcinoma in an academic medical center.
  
  
  RESULTS
  During a 10-year study period, we encountered five cases in which significant damage to the SMV and its tributaries occurred. This accounts for a total of 1.6 % of all right colectomies performed for colonic adenocarcinoma.
  
  
  CONCLUSIONS
  Iatrogenic superior mesenteric vein injury is a rare, severe, and underreported complication of both open and laparoscopic right colectomy for colonic adenocarcinoma. We identified several mechanisms of injury such as anatomic misperception, excessive traction and pulling on the venous system, extensive tumor involvement of the mesentery, and uncontrolled suturing attempts at hemostasis. We believe that increased awareness of this complication with profound understanding of vascular anatomy and the different mechanisms of injury will allow surgeons to avoid this often devastating complication.
authors.affiliation: Department of General Surgery, Shaare Zedek Medical Center, Affiliated with the Hebrew University School of Medicine, Jerusalem, Israel. mikifreund@hotmail.com.
authors.forename: M R
authors.initials: MR
authors.lastname: Freund
authors.affiliation: Department of General Surgery, Shaare Zedek Medical Center, Affiliated with the Hebrew University School of Medicine, Jerusalem, Israel.
authors.forename: Y
authors.initials: Y
authors.lastname: Edden
authors.affiliation: Department of General Surgery, Shaare Zedek Medical Center, Affiliated with the Hebrew University School of Medicine, Jerusalem, Israel.
authors.forename: P
authors.initials: P
authors.lastname: Reissman
authors.affiliation: Department of General Surgery, Shaare Zedek Medical Center, Affiliated with the Hebrew University School of Medicine, Jerusalem, Israel.
authors.forename: A
authors.initials: A
authors.lastname: Dagan
mesh_terms: D006801:Humans; D007049:Iatrogenic Disease; D008026:Ligation / Q000009:adverse effects*; D008642:Mesenteric Veins / Q000293:injuries* / Q000473:pathology; D012189:Retrospective Studies
keywords: Colonic adenocarcinoma; Complete mesocolic excision (CME); High ligation; Iatrogenic; Right colectomy; Superior mesenteric vein (SMV)