Ileocolic Artery Research Articles

Variations in right colic vascular anatomy observed during laparoscopic right colectomy

BackgroundThis study aimed to analyze right colonic vascular variability.MethodsThe study included 60 consecutive patients who underwent laparoscopic radical right colectomy and D3 lymph node dissection for malignant colonic cancer on the ileocecal valve, ascending colon or hepatic flexure (March 2013 to October 2016). The videos of the 60 surgical procedures were collected. Variations of right colonic vascular anatomy were retrospectively analyzed based on 60 high-resolution surgical videos of laparoscopic surgery.ResultsThe superior mesenteric artery and vein were present in all cases; 95.0% (57/60) had the superior mesenteric artery on the left side of the superior mesenteric vein. The ileocolic artery and vein occurred in 96.7% (58/60) and 100% (60/60) of cases, respectively; 50.0% (29/58) had the ileocolic artery passing the superior mesenteric vein anteriorly. Thirty-three (55.0%) cases had a right colic artery, and 2 (3.33%) had a double right colic artery; 90.9% (30/36) had the right colic vein passing anterior to the superior mesenteric artery. Fifty-six (93.3%) cases had a right colic vein; 7 (12.5%) had a right colic vein accompanied by a right colic artery, 66.1% (37/56) had the right colic vein draining into the gastrocolic trunk of Henle, 23.2% (13/56) had the right colic vein directly draining into superior mesenteric vein, and 10.7% (6/56) had one right colic vein draining into the superior mesenteric vein and the other into the gastrocolic trunk of Henle. Fifty-three (88.3%) cases had a gastrocolic trunk of Henle: a gastrocolic trunk in 35.8% (19/53), a gastropancreatic trunk in 9.4% (5/53), and a gastropancreaticocolic trunk in 54.7% (29/53). The frequencies of middle colic artery and vein were respectively 100% (60/60) and 93.3% (56/60).ConclusionsRight colonic vascular variations were classified in Chinese patients. Notable findings included a superior mesenteric artery positioned to the right of the superior mesenteric vein and variation in middle colic artery length. This knowledge may be helpful to colorectal surgeons and could potentially help to improve safety by reducing vascular complications during minimally invasive procedures.

A new parameter in the diagnosis of acute appendicitis: Ileocolic artery and vein diameter measurements

Aim: To determine the ability of ileocolic artery (ICA) and ileocolic vein (ICV) diameter measurements in the diagnosis of acute appendicitis.Material and Methods: ICA, ICV, abdominal aorta (AA) and inferior vena cava (IVC) diameters were recorded in 123 patients. Patients were grouped according to the presence of acute appendicitis clinically-radiologically. The receiver operating characteristic (ROC) curves were constructed to obtain the cutoff values ​​in terms of differentiation of appendicitis and control groups.Results: ICA, ICV, ICA/AA and ICV/IVC measurements differed significantly between the appendicitis (n=75) and control (n=48) groups (p 0.001, p 0.001, p =0.003, p =0.006). The best cutoff values for ICA and ICV to differentiate appendicitis from the control group were 2.92 mm and 4.28 mm, respectively. The ICA, with a cut-off point based on the ROC curve, of 2.92 mm provided a sensitivity of 70.7%, and a specificity of 70.8%. Applying the cut-off point of 4.28 mm for ICV, generated a sensitivity of 80%, and a specificity of 72.9%.Conclusion: Measurements of the ICA and ICV diameter in computed tomography (CT) is a promising application for determining acute appendicitis. This preliminary study suggests ICA and ICV diameter measurements could contribute as an alternative parameter to major radiological evidence in the diagnosis of acute appendicitis.Keywords: Ileocolic artery; ileocolic vein; acute appendicitis; abdominal; computed tomography.

Three-dimensional computed tomographic angiography with computed tomographic colonography for laparoscopic colorectal surgery.

To prospectively correlate the preoperative vessel anatomy in three-dimensional computed tomographic angiography with computed tomographic colonography (3D-CTA with CTC) with that in laparoscopic surgery for colorectal cancer. The study protocol was approved by our institutional review board. The study population consisted of 101 patients with colon cancer who underwent 3D-CTA with CTC between June 2016 and January 2018. Two radiologists assessed the branching patterns of sigmoid arteries (SAs) and right colonic artery (RCA), the position between the ileocolic artery (ICA) and superior mesenteric vein (SMV), and the existence of an accessory middle colonic artery (aMCA). The vessel anatomy on 3D-CTA with CTC was correlated with that of intraoperative findings. Ninety-eight examinations (97.0%) were technically successful. Between preoperative and intraoperative vessel anatomy, the branching patterns of SAs were concordant in all 29 cases with rectosigmoid and descending colon cancer. The branching patterns of RCA and the position between the ICA and SMV were completely concordant in 32 cases of cecal and ascending colon cancer. No aMCA was identified either intraoperatively or by imaging analysis. 3D-CTA with CTC guided the surgeons to determine the resection margin of the relevant vessels for laparoscopic colorectal surgery.

Lymph node metastases in splenic flexure colon cancer: Is subtotal colectomy warranted?

Tumors of the splenic flexure (TSF) can be associated with metastatic lymph nodes (LN) along the left colic pedicle, but also along the superior mesenteric vessels. We aimed to detail the anatomical distribution of metastatic LNs in patients undergoing elective subtotal colectomy for TSF. Between 2000 and 2016, 65 patients were included. At pathological analysis, LNs were classified into two groups: locoregional LN (along the left colic artery) and distant LN (along the middle colic, right colic, and ileocolic arteries). The median number of LNs examined was 20. Eighteen patients (27%) were pN+. Among them, six (33% of pN+ patients and 9% of the series) had at least one positive distant LN. All these patients had a positive distant LN along the right colic artery. These patients had a significantly advanced stage and more positive LNs than the others (stage III-IV: 100% vs 22%, P = 0.0009 and 6 [3-15] vs 0 [0-15], P < 0.0001, respectively). The presence of synchronous metastases was predictor of metastatic distant LNs (P = 0.042). Elective subtotal colectomy for TSF allows to discover distant positive LNs in nearly 10% of patients. For those having TSF and synchronous metastatic disease enable to resection, subtotal colectomy should be recommended.

Implementation of 3D printed superior mesenteric vascular models for surgical planning and/or navigation in right colectomy with extended D3 mesenterectomy: comparison of virtual and physical models to the anatomy found at surgery.

Three-dimensional (3D) printing technology has recently been well approved as an emerging technology in various fields of medical education and practice; e.g., there are numerous studies evaluating 3D printouts of solid organs. Complex surgery such as extended mesenterectomy imposes a need to analyze also the accuracy of 3D printouts of more mobile and complex structures like the diversity of vascular arborization within the central mesentery. The objective of this study was to evaluate the linear dimensional anatomy landmark differences of the superior mesenteric artery and vein between (1) 3D virtual models, (2) 3D printouts, and (3) peroperative measurements. The study included 22 patients from the ongoing prospective multicenter trial "Safe Radical D3 Right Hemicolectomy for Cancer through Preoperative Biphasic MDCT Angiography," with preoperative CT and peroperative measurements. The patients were operated in Norway between January 2016 and 2017. Their CT datasets underwent 3D volume rendering andsegmentation, and the virtual 3D model produced was then exported for stereolithography 3D printing. Four parameters were measured: distance between the origins of the ileocolic and the middle colic artery, distance between the termination of the gastrocolic trunk and the ileocolic vein, and the calibers of the middle colic and ileocolic arteries. The inter-arterial distance has proven a strong correlation between all the three modalities implied (Pearson's coefficient 0.968, 0.956, 0.779, respectively), while inter-venous distances showed a weak correlation between peroperative measurements and both virtual and physical models. This study showed acceptable dimensional inter-arterial correlations between 3D printed models, 3D virtual models and authentic soft tissue anatomy of the central mesenteric vessels, and weaker inter-venous correlations between all the models, reflecting the highly variable nature of veins in situ.

Value of the multi-slice spiral CT angiography, CT colonography and image fusion technology in preoperative evaluation of laparoscopic right colon cancer

Objective To observe the distribution and variation of right colonic vessels, and investigate the clinical value of computed tomography angiography (CTA), computed tomography colonography (CTC) and image fusion technology in preoperative evaluation of laparoscopic right colonic cancer (RCC). Methods The retrospective and descriptive study was conducted. The clinicopathological data of 38 patients who underwent laparoscopic extended radical resection of RCC + D3 lymphadenectomy in the Affiliated Wuxi Second People′s Hospital of Nanjing Medical University between January 2015 and July 2017 were collected. Patients received preoperative plain and enhanced scans of abdominal and pelvic CT. The original images were reconstructed and fused by CTA and CTC, and then coming out with three-dimensional images of blood vessels and gut. Observation indicators: (1) branches of superior mesenteric artery (SMA); (2) positional relationship between SMA and superior mesenteric vein (SMV); (3) composition of gastrocolic venous trunk. Results Scan images of 38 patients had fused with scan images of vessels and primary tumors and reached the diagnostic standard, with a good imaging performance. Distribution of blood vessels of virtual reality (VR) images and were compared with that of naked blood vessels under intraoperative laparoscopy, showing a coincidence rate of 100.0%(38/38). (1) Branches of SMA: results of CTA and intraoperative anatomy showed that the occurrence rate of the right colonic artery, middle colonic artery and ileocolic artery were respectively 94.7%(36/38), 92.1%(35/38) and 100.0%(38/38). A right colonic artery was found in 28 patients. Ten patients had structure variation of right colonic artery, including 3 with 2 right colonic arteries and 2 without right colonic artery. The right colonic artery and middle colonic artery merged into the same trunk and then flowed into SMA were detected in 2 patients; the right colonic artery and ileocolic artery merged into the same trunk and then flowed into SMA were detected in 3 patients. (2) Positional relationship between SMA and SMV: results of CTA and intraoperative anatomy showed that the occurrence rate of both SMA and SMV was 100.0%(38/38). The SMA in 20 patients was located in the ventral side of SMV; SMA in 18 patients was located in the dorsal side of SMV. (3) Composition of gastrocolic venous trunk: results of CTA and intraoperative anatomy showed that 29 of 38 patients had gastrocolic venous trunks, which belonged to four sources, including right colonic vein, middle colonic vein, right gastric epiploic vein and anterior superior pancreaticoduodenal vein. Among 29 patients, 18 had 2- or 3-branch type of gastrocolic trunk that consisted of the right gastric epiploic vein, middle colonic vein and right colonic vein; 3 had 2-branch type of gastric pancreatic trunk that consisted of the right gastric epiploic vein and anterior superior pancreaticoduodenal vein; 8 had 3- or 4-branch type of stomach-pancreas-colon trunk that consisted of right gastric epiploic vein, anterior superior pancreaticoduodenal vein, right colonic vein and middle colonic vein. Conclusion CTA, CTC and image fusion technology can intuitively show the anatomy and variation of right colonic vessels, with a high clinical value. Key words: Colonic neoplasms; Preoperative evaluation; Vascular reconstruction; Computed tomography angiography; Computed tomography colonography; Extend right hemicolectomy; Laparoscopy

Surgical Anatomy of the Superior Mesenteric Vessels Related to Colon and Pancreatic Surgery: A Systematic Review and Meta-Analysis

The surgeon dissecting the base of the mesenterium, around the superior mesenteric vein (SMV) and artery, is facing a complex tridimensional vascular anatomy and should be aware of the anatomical variants in this area. The aim of this systematic review is to propose a standardized terminology of the superior mesenteric vessels, with impact in colon and pancreatic resections. We conducted a systematic search in PubMed/MEDLINE and Google Scholar databases up to March 2017. Forty-five studies, involving a total of 6090 specimens were included in the present meta-analysis. The pooled prevalence of the ileocolic, right colic and middle colic arteries was 99.8%, 60.1%, and 94.6%, respectively. The superior right colic vein and Henle trunk were present in 73.9%, and 89.7% of specimens, respectively. In conclusion, the infra-pancreatic anatomy of the superior mesenteric vessels is widely variable. We propose the term Henle trunk to be used for any venous confluence between gastric, pancreatic and colic veins, which drains between the inferior border of the pancreas and up to 20 mm downward on the right-anterior aspect of the SMV. The term gastrocolic trunk should not be synonymous, but a subgroup of the Henle trunk, together with to gastropancreatocolic, gastropancreatic, or colopancreatic trunk.

Defining minimal clearances for adequate lymphatic resection relevant to right colectomy for cancer: a post-mortem study.

There has been a lengthy discussion on the extent of lymphatic resection for right-sided colon cancer and the central borders of the mesentery that are not yet defined. The objectives of this study are to define minimal clearances for adequate lymphatic resection in regard to colic artery origins and the superior mesenteric artery (SMA) and vein (SMV) relevant to right colectomy. Central mesenteric lymph vessels, nodes, and blood vessels were dissected in 16 cadavers. Cranial-caudal clearances were defined as distances between an individual colic artery origin (ileocolic, right colic, and median colic artery) and the outermost lymphatic vessel within its lymphovascular bundle, cranial and caudal along the SMA. Long lymphatic vessels crossing the SMV between arterial bundles were counted and they constituted the medial clearances. An arbitrary watershed between small bowel and colonic lymph was localized. Immunohistochemistry was performed to histologically verify lymphatic vessels. Cranial-caudal clearances were ileocolic 3.6 ± 1.9 and 5.7 ± 1.9; right colic 2.8 ± 1.6 and 3.3 ± 1.0; middle colic artery bundle 6.3 ± 2.7 and 5.9 ± 2.4mm, respectively. Long lymphatic vessels crossing the SMV between arterial buntles and approaching the SMA were found in all cadavers (antero/posteriorly in 12, only anteriorly in 4), median 3.5 (1-7) long lymphatic vessels anteriorly, and 1.5 (0-5) posteriorly per cadaver. Right colonic lymphovascular bundles are volumes of mesenteric tissue that surround the superior mesenteric vessels anteriorly and posteriorly. Long lymphatic vessels traverse the superior mesenteric vein anteriorly/posteriorly approaching the superior mesenteric artery between arterial bundles and placing the medial clearance on the left side of the artery. These do not correlate to arterial crossing patterns. Cranial-caudal clearances determine the tissue to be removed superior/inferior to arterial origins together with long lymphatic vessels transversing independently between the lymphovascular bundles placing the weight of lymphatic resection on the mesenteric tissue and not on the level of vessel division (High tie).

Anatomske variacije vej, ki izhajajo iz zgornje mezenterične arterije

Superior mesenteric artery, the second ventral branch of the abdominal aorta, supplies the distal duodenum, the small intestine, and the large intestine to the mid transverse colon. Superior mesenteric artery branches include the inferior anterior and inferior posterior pancreaticoduodenal arteries, middle colic artery, right colic artery, ileocolic artery, jejunal and ileal branches. The vascular anatomy of superior mesenteric branches is frequently variant. The explanation of variant vascular anatomy of branches and pathological consequences of diseases which impact the mesenteric vasculature might be due to the changes that appear in the development of ventral splanchnic arteries and their blood supply. Knowledge of mesenterical variations is valuable to radiologists and surgeons.

Macroscopic Aspects of the Cranial Mesenteric Artery (Arteria Mesenterica Cranialis) in Chinchilla Lanigera Species

In this study we have used 10 carcasses of chinchilla females slaughtered by the owner for commercial purposes. The studied animals have been subjected to an antemortem exam in which the semiological constants like: temperature; breats per minute and pulse were recorded. After the examination the subjects were declared clinically healthy. After skinning 30 ml coloring agent was injected intraluminally and dissection of the cranial mesenteric artery was performed. The first collateral branch of this vessel was the caudal pancreatico-duodenal artery (Arteria pancreaticoduodenalis caudalis), followed by 4-5 jejunal arteries (Arteriae jejunales). The cranial mesenteric artery gives off the dorsal cecal artery (Arteria cecalis dorsalis) as one of terminal branches to supply the haustrated part of cecum, the medial cecal artery (Arteria cecalis media) distributed to the tubular part of cecum (second terminal) and ileocolic artery (Arteria ileocolica)(the third terminal). To the best of our knowledge, our results brings significant information about the blood supply of intestines in chinchilla, that could be a real help for clinicians and researchers studying this topic.

Inflammatory aneurysm of ileocolic artery discovered on fluorine 18-fluorodeoxyglucose-positron emission tomography/computed tomography

Inflammatory aneurysm of ileocolic artery discovered on fluorine 18-fluorodeoxyglucose-positron emission tomography/computed tomography

Three-Dimensional Cross-Sectional Light-Sheet Microscopy Imaging of the Inflamed Mouse Gut

Three-Dimensional Cross-Sectional Light-Sheet Microscopy Imaging of the Inflamed Mouse Gut

Variation and treatment of vessels in laparoscopic right hemicolectomy.

With the introduction of complete mesocolic excision (CME) and the application of laparoscopic technique, surgery for colon cancer has become more standardized and the curative effect has improved [1]. The key points in laparoscopic right hemicolectomy are high ligation of main vessels and root dissection of lymph nodes. The wide range of variations in vascular architecture and intraoperative bleeding are common causes of prolonged surgical time, wound hemorrhage, and even transfer to the opening operation. The superior mesenteric vein (SMV) is the most important anatomical landmark in CME for the right colon, and guides all the steps of lymph node dissection. The SMV appears as a pale blue bulge on laparoscopy, which enables accurate positioning. The ileocolic vessel pedicle is relatively constant and facilitates accurate positioning. The intersection of the ileocolic vessel pedicle and the SMV is the optimal starting point in laparoscopic right hemicolectomy using a medial-to-lateral approach. A sheath with an avascular plane can be reached after opening the SMV vascular sheath, which results in less bleeding and enables vascular root and thorough lymph node dissection. The first step is to manage the ileocolic vessels. The ileocolic artery (ICA) is located anterior to the ileocolic vein (ICV) for about one-third of the incidence. The ileocolic vessels are relatively long and are easy to work with. In the vast majority of cases, the ICV drains into the SMV, and into the gastrocolic trunk (GCT) in about 2.5% of cases. The reported incidence of a right colic artery (RCA) is controversial; the RCA is absent in about 50% of cases and often crosses the SMV. The right colic vein (RCV) usually drains into the GCT, but sometimes drains directly into the SMV. The middle colic vessels have great variability and a close anatomical relationship with the pancreas, duodenum, and GCT. Moreover, the transverse colon and mesentery are long, and root positioning and processing of the middle colic vein (MCV) are relatively difficult. With the SMV and pancreas as anatomic landmarks, it is more feasible to locate the blood vessels in the neck of the pancreas. The middle colic artery (MCA) originates from the superior mesenteric artery (SMA), and the distance from the inferior border of the pancreas differs slightly in the literature, but is at the most 5cm. Identification of the MCA trunk and branches, as well as the common origin of the MCA and RCA, is of great importance for the maintaining the blood supply during surgery for primary colon cancer. The MCV mainly drains into the SMV and GCT; however, if branching variation drains into the jejunal vein, inferior mesenteric vein, or splenic vein, the effect is serious when a vessel is torn. Isolation of the GCT is the step at which bleeding will likely occur in standard right resection and is a difficult stage of the surgery. The GCT has five origins including the right gastroepiploic vein (RGV), right colic vein (RCV), accessory right colic vein (ARCV), pancreaticduodenal vein (PDV), and MCV, which can have 2, 3, or 4 branches; therefore, familiarity with variants may be helpful to avoid bleeding. Approximately 5-10% of colon cancers at the hepatic flexure have No. 6 group lymph node metastasis, and laparoscopic radical extended right hemicolectomy requires thorough dissection of No. 6 group lymph nodes and the omental arcade 10cm from the pylorus. The inferior arteriovenous vessels are a common source of bleeding, and the RGV can serve as a clue to finding the artery. The core area of laparoscopic radical extended right hemicolectomy includes the pancreatic neck, duodenum, and right gastroepiploic vessels. The difficulty lies with the standard treatment of the GCT. A medial-to-lateral approach is more in line with the principle of no-touch in tumor surgery and is applied from lower to upper, inside to outside, and left to right, for both the vessels and plane of dissection. Familiarity with vascular variation and the management of vessels in key areas are essential for successful surgery.

Innovative Sphincter Preserving Pull-Through Technique with en Bloc Colon and Small Bowel Transplantation

With improved intestinal allograft survival, colon transplantation is becoming increasingly common. A new technique of sphincter-preserving pull-through operation with colo-intestinal transplantation (CIT) was done in five patients. 3 of the five patients had their stomas closed with good continence. All patients are nutritionally independent with functioning allografts. Between 2008 and 2016, 5 patients underwent sphincter preserving pull-through technique with en bloc CIT. 4 had shortgut syndrome related to endstage Crohn’s disease and one was transplanted for dysmotility related to Ehler-Danlos syndrome. Immunosuppression consisted of alemtuzumab induction followed by tacrolimus and steroid. Arterial inflow was provided by infrarenal aortic graft. Venous drainage was portal (n=3) or systemic (n=2). Donor procurement: Middle colic artery was ligated proximal to its bifurcation to preserve continuity of arterial arcades and avoid injury to the inferior pancreaticoduodenal artery to allow for use of pancreas as a solitary allograft. IMA was ligated close to its origin. Small bowel and colon were retrieved en bloc. Ileocolic and right colic arteries were the main axial blood supply via the marginal arcades. Allograft implantation: After anastomosing the vascular conduits to the recipient infrarenal aorta and superior mesenteric vein or IVC, vascular anastomoses were accomplished to the respective conduits followed by revascularization. Proximal jejunum was anastomosed to the native duodenum (Figure). The abdomen was closed with an end-colostomy in 4 patients. In 1 patient creation of an end stoma was deferred. Intersphincteric resection of the rectum with colo-anal anastomosis. Between 2nd and 11th postoperative day all 5 patients underwent intersphincteric resection of the rectum with colo-anal anastomosis. In stirrup position with a transabdominal assist, the rectal segment was fully excised through a transanal intersphincteric approach leaving the external anal sphincter intact. Transplanted large bowel was delivered through the pelvic hiatus with no tension or malrotation and anastomosed to the anal verge. The abdomen was closed and a simple loop ileostomy 20 cm proximal to the ileocecal valve was created (Figure 1). Ileostomy was closed in 3/5 patients between 4 and 11 months post transplantation. 2 patients 3 and 14 month post transplantation are are awaiting stoma closure.FigureResults: All patients currently are doing well with good allograft function between 3 months and 8 years post-transplant. All are nutritionally independent. 2/3 patients who underwent stoma closure have full continence. One patient is partially continent 23 months following transplantation. This novel technique of CIT improves allograft’s absorptive capacity and quality of life in select patients with preserved anal sphincter. Wiley Periodicals Inc. for Figure.

The impact of three-dimensional reconstruction on laparoscopic-assisted surgery for right-sided colon cancer.

IntroductionDuring laparoscopic-assisted colorectal surgery (LACS) for right-sided colon cancer patients, we performed three-dimensional (3D) surgical simulation to investigate vascular anatomy, including the ileocolic artery (ICA), right colic artery (RCA) and superior mesenteric vein (SMV).AimWe also used 3D imaging to examine the shortest distance from the root of the ileocolic vein (ICV) to the gastrocolic trunk (GCT).Material and methodsWe analyzed 46 right-sided colon cancer patients who underwent 3D-simulated LACS. We also examined a control group of 20 right-sided colon cancer patients who underwent LACS without 3D imaging. Patients who received such assessments were classified into the following two groups based on the vessel arrangement patterns of the ICA and SMV: the type A group, in which the ICA crosses anterior to the SMV, and the type B group, in which the ICA crosses posterior to the SMV. The shortest length from the root of the ICV to the GCT (D mm) was measured via 3D imaging. Patient characteristics and perioperative outcomes for these three groups were compared.ResultsThe mean D mm for all cases was 29.2 ±5.21 mm. Mean D mm values for the type A and type B groups were 27.8 ±4.21 and 30.5 ±5.53 mm, respectively. Intraoperative blood loss was lower in the type A group (41.8 ±27.5 g) and the type B group (44.5 ±31.6 g) than that in the control group (86.8 ±27.5 g) (p = 0.013).Conclusions3D imaging was useful for understanding anatomical relationships during LACS.

Anatomical studies on the cranial and caudal mesenteric arteries of the Barbados Black Belly sheep

Abstract Introduction: The Barbados Black Belly is a breed of domestic sheep in the Caribbean island of Trinidad. Anatomical studies on the cranial and caudal mesenteric arteries are necessary to know the pattern of its blood supply to gain information in benefit of experimental surgery. Materials and Methods: The thoracic part of the aorta of five sheep was injected with red latex. Careful gross dissection of the cranial and caudal mesenteric arteries was performed either after embedding in 10% formalin solution for 2-3 days. Results: The cranial mesenteric artery originated from the abdominal aorta, caudally to the celiac trunk, giving caudal duodenal artery, jejunal arteries, ileal arteries, ileocolic artery and middle colic artery. The caudal mesenteric artery arises from the aorta, cranially to the external iliac arteries, originating the left colic and cranial rectal arteries. Conclusion: cranial and caudal mesenteric arteries supplied the small and large intestine of the Barbados Black Belly sheep except caudal part of the large intestine which were supplied by the middle and caudal rectal arteries.

Variations in the Vascular Anatomy of the Right Colon and Implications for Right-Sided Colon Surgery.

Knowledge of the normal pattern and variations of the blood supply of the right colon is crucial for better outcomes after colon surgery. The purpose of this study was to describe the precise vascular anatomy of the right colon according to surgical perspective. Adult fresh cadavers were dissected between January 2013 and October 2015, focusing on the venous and arterial anatomy of the right side of the colon. Macroscopic anatomical dissections were performed on 111 adult fresh cadavers with emphasis on the vascular anatomy of the right colon. The colic tributaries of the superior mesenteric artery and vein were documented in writing. Furthermore, the dissections were recorded with a video camera. The incidence of colic arteries arising from the superior mesenteric artery included ileocolic artery, 100%; right colic artery, 33.3%; middle colic artery, 100%; and accessory middle colic artery, 11,7%. All 111 cadavers had a single ileocolic vein, which drained into the superior mesenteric vein in 103 cases (92.8%), into the gastro-pancreatico-colic trunk in 7 cases (6.3%), and into the jejunal trunk in 1 case (0.9%). The drainage site of the ileocolic vein to the superior mesenteric vein varied, and in 9% of cases the ileocolic vein did not accompany the ileocolic artery. The gastro-pancreatico-colic trunk was detected in 87 cases (78.4%); with several forms of the origin of the respective branches, the gastropancreatic trunk was detected in 24 cases (21.6), and the classic gastrocolic trunk of Henle was not detected. Variations were found in the formation and drainage routes of other venous colic tributaries of the superior mesenteric vein. This study is limited by its use of cadavers in that it is impossible to trace each vessel to its origin in live surgery. Surgeons must watch, observe, and bear in mind that vascular variations can occur. Awareness of these complex variations may improve the quality of surgery and may prevent devastating complications during right-sided colon resections.

Intraoperative Archive of Right Colonic Vascular Variability Aids Central Vascular Ligation and Redefines Gastrocolic Trunk of Henle Variants.

Vascular supply to the right colon has become an issue because of high variability and subsequent impact on minimally invasive surgery. Past cadaveric or radiologic anatomic assessments are noncomprehensive. Intraoperative charting of right colonic arteriovenous anatomy was undertaken to determine the incidence and scope of vascular variations. Vascular anatomy variations were documented in snapshot images, captured during laparoscopic video recordings or through open surgical digital photography. Data were drawn from consecutive right hemicolectomies, routinely entailing complete mesocolic excision with central vascular ligation. Seventy patients (mean age, 62.7 years; 37 women (52.8%); 33 men (47.2%)), each with surgically treatable right-sided colon cancer, were prospectively studied. Both ileocolic and middle colic arteries were regularly identified (100%), with right colic artery present in 41.4% of patients. Ileocolic and middle colic veins consistently drained into the right colon. Although the ileocolic vein always emptied into the superior mesenteric vein, drainage of the middle colic vein was split (superior mesenteric vein, 94.3%; gastrocolic trunk of Henle, 5.3%), as was drainage of the right colic (superior mesenteric vein, 43.3%; gastrocolic trunk of Henle, 56.7%) and accessory middle colic veins (superior mesenteric vein, 54.5%; gastrocolic trunk of Henle, 45.5%), present in 42.9% and 15.7% of patients. Gastrocolic trunk of Henle was found in 88.6% of patients, usually draining into the superior mesenteric vein. No significant sex-related differences were present regarding the incidence and scope of variability displayed by the right colic artery, right colic vein, accessory middle colic vein, or gastrocolic trunk of Henle classification (p > 0.05). The inconsistency between cadaver and live surgery anatomy and the low BMI of the Asian population might be drawbacks of our study. Variations in right colonic arteriovenous channels, assessed intraoperatively, corroborate those established by cadaveric and radiologic means, prompting a new gastrocolic trunk of Henle classification.

Optimization of ileocystoplasty in bladder cancer patients after cystectomy

Introduction. Surgery remains the main method of treatment of patients with bladder cancer, and the only radical surgery is cystectomy with lymphadenectomy and a rationally selected method of urinary diversion. In the Chelyabinsk Regional Clinical Oncological Dispensary, an original method of orthotopic neobladder reconstruction in bladder cancer patients was developed. Objective: to improve the results of surgical treatment and the quality of life of patients with bladder cancer who underwent cystectomy. Materials and methods. The article presents results of a study of patients with bladder cancer who underwent orthotopic ileocystoplasty after radical cystectomy using a unique original technique. The reservoir was formed using a segment of the ileum of 45–50 cm in length with a 20–25 cm offset from the ileocecal junction. It’s important to preserve nutrition of the resected fragment. One of the branches of the ileocolic artery supplies blood to the distant part of the ileum which explains the necessity of the offset. After examination of the mesentery for unusual blood supply, the necessary intestinal segment was resected. Intestinal patency was restored by application of an anastomosis side-to-side with double row suture on the mucosa and serous-muscular layer. The reservoir was formed by application of an enteroenterostomy side-to-side with one row inverting continuous suture. Before that, the resected small-intestinal segment was detubulized (dissected) through the antimesenteric margin for 12–15 cm. Results. This method has the lowest rate of complications; doesn»t affect overall, cancer-specific and recurrence-free survival. Conclusion. The proposed method of neobladder formation allows to significantly improve the results of bladder cancer treatment.

ВИБІР ЖИВЛЯЧИХ СУДИН ПРИ ПРОВЕДЕННІ ЕЗОФАГОПЛАСТИКИ ІЛЕОЦЕКАЛЬНИМ СЕГМЕНТОМ

Стаття присвячена визначенню вибору живлячих судин під час мобілізації ілеоцекального сегмента для езофагопластики методом проточної ДНК-цитометрії. Вивчалась проліферативна активність клітин слизової оболонки ілеоцекального сегмента в експерименті після перев’язки клубовотовстокишкової артерії. В результаті проведеного дослідження встановлено, що на першу добу експерименту спостерігаються ішемічні зміни клітин, на третю добу – тенденція до нормалізації показників клітинного циклу, тобто, до зменшення пошкоджуючого фактору ішемії. Але, на сьому добу ще не відбувається повної адаптації ілеоцекального сегмента до ішемічних змін. Тому дану артерію при мобілізації ілеоцекального сегмента слід зберігати, як живлячу ніжку. В клініці езофагопластика ілеоцекальним сегментом була виконана у 13 хворих. Серед післяопераційних ускладнень була часткова неспроможність езофагоілеоанастомозу у двох випадках. Післяопераційної летальності не було.