The Dilemma of the Level of the Inferior Mesenteric Artery Ligation in the Treatment of Diverticular Disease: A Systematic Review of the Literature.

Roberto Cirocchi,Georgi Popivanov,Giovanni Domenico Tebala,Bruno Amato,Giulio Mari,Riccardo Nascimbeni,Stefano Avenia

doi:10.3390/jcm11040917

Abstract

Background and aim: Although sigmoidectomy is a well-standardized procedure for diverticular disease, there are still unclear areas related to the varying morphology and vascular supply of the sigmoid colon. The level of vascular ligation could affect the functional outcomes of patients operated on for diverticular disease. The aim of this review is to primarily evaluate sexual, urinary and defecatory function outcomes, as well as postoperative results, in patients who underwent surgery for diverticular disease, with or without inferior mesenteric artery (IMA) preservation. Materials and methods: The MEDLINE/PubMed, WOS and Scopus databases were interrogated. Comparative studies including patients who underwent sigmoidectomy for diverticular diseases were considered. Bowel function, genitourinary function, anastomotic leak, operation time, conversion to open surgery, anastomotic bleeding, bowel obstruction were the main items of interest. Results: Twelve studies were included in the review, three randomized and nine comparative studies. Bowel and genitourinary function are not differently affected by the level of vascular ligation. The site of ligation of IMA did not influence the rate of functional complications, anastomotic leak and bleeding. Of note, the preservation of IMA is associated with a higher conversion rate and longer operative time. Conclusions: Despite the heterogeneity of patient groups, and although the findings should be interpreted with caution, functional and clinical outcomes after sigmoidectomy for diverticular disease do not seem to be affected by the level of vascular ligation as long as the IMA is ligated far from its origin.

Highlights

IntroductionSigmoidectomy and left hemicolectomy are the most commonly performed surgical procedures for symptomatic or complicated left-sided colonic diverticulosis
Studies included a total of 2812 pooled patients as follows: 1612 underwent inferior mesenteric artery (IMA) ligation (IL) versus 1200 with IMA
The debate about the level of vascular ligation ligation during during elective elective sigmoidectomy sigmoidectomy for for diverticular disease has changed over the past few years

Summary

Introduction

Sigmoidectomy and left hemicolectomy are the most commonly performed surgical procedures for symptomatic or complicated left-sided colonic diverticulosis. There is a general agreement that the sigmoid colon must be completely removed as it is the most common location of diverticulosis and diverticulitis in the Western world. Sigmoidectomy is a well-standardized procedure, some technical variations exist according to the different morphologies and the vascularization of the sigmoid colon as follows: length of S-shaped loop between 11.9 and 91.1 cm, width of the sigmoid mesocolon between. 4 and 11.5 cm [1], a highly variable pattern of sigmoid arteries—mainly divided into a common origin type—a separated origin or common trunk of the sigmoid arteries from the descending recto-sigmoid trunk [2] and the absence of the left colic artery [3]. Sigmoid resection is associated with an acceptable morbidity rate

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