Inferior mesenteric artery preservation techniques in the treatment of diverticular disease: a systematic review of the literature.

IF 2.5 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

International Journal of Colorectal Disease Pub Date : 2024-10-28 DOI:10.1007/s00384-024-04746-0

Stefano Agnesi, Francesco Virgilio, Alice Frontali, Greta Zoni, Mariagiulia Giugliano, Claudio Missaglia, Andrea Balla, Pierpaolo Sileri, Andrea Vignali

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引用次数: 0

Abstract

Purpose: The aim of this study is to analyze the impact of different surgical techniques used to preserve the inferior mesenteric artery on patient outcomes following left colonic resection.

Methods: A search was conducted in PubMed, Embase and Web of Science, founding 4795 articles. The review was registered on PROSPERO (registration number: CRD42024572291).

Results: Eleven articles published between 2001 and 2023, including 989 patients were the object of the present systematic review. Two hundred sixty-two patients (26.5%) underwent Valdoni's technique (Group A), which involves the skeletonization of the IMA, 272 (27.5%) underwent tubular resection (Group B), and 455 (46%) underwent peripheral dissection on sigmoid vessels (Group C). Laparoscopic surgery was predominant in Groups B (100%) and C (94.7%), while Group A had fewer laparoscopic procedures (44.6%). Patients in Group A experienced longer operative times (174.5 ± 27.4 min) and hospital stays (11.4 ± 3.6 days) compared to Groups B and C (165.9 min and 152.35 ± 46.9 min; 8.4 ± 5.7 days and 8.3 ± 3.6 days, respectively). Group A exhibited higher rates of anastomotic leakage (5%) compared to Group C (1.1%) and a higher incidence of bleeding (13%) compared to Group B (1.8%).

Conclusion: Valdoni's technique is less favourable for IMA preservation in left colon resection for diverticular disease. Peripheral dissection of sigmoid vessels or tubular resection is recommended for IMA preservation in this context.

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肠系膜下动脉保留技术在憩室疾病治疗中的应用：文献系统回顾。

目的：本研究旨在分析保留肠系膜下动脉的不同手术技术对左结肠切除术后患者预后的影响：在 PubMed、Embase 和 Web of Science 中进行了检索，共发现 4795 篇文章。该综述已在 PROSPERO 上注册（注册号：CRD42024572291）：本系统综述的对象是2001年至2023年间发表的11篇文章，包括989名患者。262 名患者（26.5%）接受了瓦尔多尼技术（A 组），包括 IMA 骨架化；272 名患者（27.5%）接受了管状切除术（B 组）；455 名患者（46%）接受了乙状结肠血管外围解剖（C 组）。B 组（100%）和 C 组（94.7%）主要采用腹腔镜手术，而 A 组采用腹腔镜手术的人数较少（44.6%）。与 B 组和 C 组（分别为 165.9 分钟和 152.35 ± 46.9 分钟；8.4 ± 5.7 天和 8.3 ± 3.6 天）相比，A 组患者的手术时间（174.5 ± 27.4 分钟）和住院时间（11.4 ± 3.6 天）更长。A组吻合口漏发生率（5%）高于C组（1.1%），出血发生率（13%）高于B组（1.8%）：结论：在左侧结肠憩室疾病切除术中，Valdoni 技术对保留 IMA 的效果较差。在这种情况下，建议采用乙状结肠血管周边剥离术或管状切除术来保留 IMA。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

International Journal of Colorectal Disease 医学-外科

CiteScore

4.90

自引率

3.60%

发文量

206

审稿时长

3-8 weeks

期刊介绍： The International Journal of Colorectal Disease, Clinical and Molecular Gastroenterology and Surgery aims to publish novel and state-of-the-art papers which deal with the physiology and pathophysiology of diseases involving the entire gastrointestinal tract. In addition to original research articles, the following categories will be included: reviews (usually commissioned but may also be submitted), case reports, letters to the editor, and protocols on clinical studies. The journal offers its readers an interdisciplinary forum for clinical science and molecular research related to gastrointestinal disease.