Vascular anatomy of the right colon and intraoperational bleeding during laparascopic surgery

Abstract

Objective To summarize vascular anatomy and associated intraoperational bleeding in laparoscopic right hemicolectomy in Department of Colorectal Surgery, the First Affiliated Hospital of Nanjing Medical University. Methods Videos of 245 cases who received laparoscopic right hemicolectomies were collected and analyzed regarding to vascular anatomic relationship and intraoperational bleeding. Results The superior mesenteric artery and vein, ileocolic artery and vein, and middle colic artery were present in all cases. The right colic artery was present in 22.9% (56/245) of the cases. Gastrocolic venous trunk was present in most patients, 227 cases in 245 (92.7%). The overall intraoperational bleeding incidence was 19.2% (47/245). Artery related bleeding was observed in 16 cases (6.5%), among which parenchyma hemorrhage of pancreas significantly prolonged laparoscopic operation time (t=2.895, P 0.05). Venous related bleeding was viewed in 31 cases (12.7%). Most of the venous related bleeding were the gastrocolic venous trunk, and its tributaries had a higher risk of bleeding. Statistic analysis indicated that intraoperational bleeding significantly prolonged the overall operative time (P<0.05). Conclusions Vascular anatomy of right colon is complicated and variable and laparoscopic right hemicolectomy has high risk of intraoperational hemorrhage. Understanding anatomic relationship of the right colon the vessels is critical to decrease and avoid bleeding. Key words: Colonic neoplasms; Laparoscopic right hemicolectomy; Gastrocolic venous trunk; Intraoperational bleeding; Operation time