Lengthening of left colon after rectal resection: What all is adequate? A prospective cohort study

• Mobilization was adequate in 19% and 0% after low tie, 56% and 20% after low tie with splenic flexure mobilization and 100% and 86% on ligation of descending branch of left colic artery in addition to above two maneuvers, with partial and complete sigmoid resection respectively.
• Ligation of descending branch of left colic artery is safe and doesn't seem to increase the risk of anastomotic leak.
• Ligation of descending branch of left colic artery is particularly helpful if complete resection of sigmoid colon is to be contemplated.

BackgroundAdequate mobilization of colon is essential to achieve tension free anastomosis after sphinchter saving surgeries.Methods26 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.ResultsThe 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.ConclusionsLow 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.