An: 2018, Nr.2, Articol Nr. 15
ANATOMICAL VARIANTS OF INFERIOR MESENTERIC VESSELS AND SURGICAL IMPLICATIONS
G. Statescu, Al. Nemtoi, Simona Partene Vicoleanu, Allia Sindilar, A.H. Nedelcu, Anca Sava - “Grigore T. Popa” University of Medicine şi Pharmacy, Iaşi, Department of Anatomy
ANATOMICAL VARIANTS OF INFERIOR MESENTERIC VESSELS AND SURGICAL IMPLICATIONS (Abstract): The colon is one of the most common locations for cancer. Colon resection is the first treatment option in most cases of left colon cancer. Material and method: The arterial vascularisation of the left colon is based entirely on the inferior mesenteric artery and its branches. Indeed, the knowledge about the anatomy of the arterial vessels and its variants are essential to carry out a safe and correct oncological resection, given its connections with the nerves of the lumber plexus and the ureter. In the period 2016-2018 a total of 48 colonoscopically diagnosed colon cancer and pieces of resection were studied in the Department of Anatomopathology and confirmed by the anatomopathological examination and data from the operative protocol. These principles have been used to make radical curative interventions. Always the inferior mesenteric artery was ligated to its origin by making a large resection with mesocolic excision and low colorectal anastomosis. Difficulties occurred when the anatomical variants of the inferior mesenteric vessels had to be recognized intraoperatively and were not known preoperatively because the diagnosis was based exclusively on colonoscopy. The results were very good, there were no major postoperative complications. Discussions: In the curative surgical technique of the left colon cancer it is necessary to make the ligature of the lower mesenteric artery at its origin regardless of the anatomical variants that may exist, every time the mesocolic excision must be done. Anastomosis should always be done with the low colorectal sections. Conclusions: Once the colon is mobilized, the resection in oncological limits should be made at least 5 cm below the tumor and 10 cm above it. In the vast majority of cases complete left hemicolectomy should be made below the colorectal junction and even below the upper rectum for the lesion of the distal portion of the sigmoid colon considering the vascularization at this level.
Key words: ANATOMICAL VARIANTS OF IMV, SÜDECK-LERICHE VASCULAR AREA, LEFT HEMICOLECTOMYFull text