How to reduce the superior mesenteric vein bleeding risk during laparoscopic right hemicolectomy.

Autor: Garcia-Granero A; Colorectal Surgery Unit, Hospital Universitario y Politecnico la Fe, Valencia, Spain. alvarogggf@hotmail.com., Sánchez-Guillén L; Colorectal Surgery Unit, Hospital Universitario y Politecnico la Fe, Valencia, Spain., Frasson M; Colorectal Surgery Unit, Hospital Universitario y Politecnico la Fe, Valencia, Spain., Sancho Muriel J; Colorectal Surgery Unit, Hospital Universitario y Politecnico la Fe, Valencia, Spain., Alvarez Sarrado E; Colorectal Surgery Unit, Hospital Universitario y Politecnico la Fe, Valencia, Spain., Fletcher-Sanfeliu D; Cardiovascular Surgery Department, Hospital Universitario Son Espases, Palma, Mallorca, Spain., Flor Lorente B; Colorectal Surgery Unit, Hospital Universitario y Politecnico la Fe, Valencia, Spain., Pamies J; Hospital Universitario y Politecnico la Fe, Valencia, Spain., Corral Rubio J; Hospital Germans Trias i Pujol, Barcelona, Spain., Valverde Navarro AA; Surgical Anatomy Unit, Anatomy and Embryology Department, University of Valencia, Valencia, Spain., Martinez Soriano F; Surgical Anatomy Unit, Anatomy and Embryology Department, University of Valencia, Valencia, Spain., Garcia-Granero E; Colorectal Surgery Unit, Hospital Universitario y Politecnico la Fe, Valencia, Spain.
Jazyk: angličtina
Zdroj: International journal of colorectal disease [Int J Colorectal Dis] 2018 Feb; Vol. 33 (2), pp. 235-239. Date of Electronic Publication: 2017 Dec 04.
DOI: 10.1007/s00384-017-2940-3
Abstrakt: Purpose: The superior right colic vein (SRCV) has been proposed as the main cause of superior mesenteric vein bleeding by avulsion during laparoscopic right hemicolectomy. Our objective is to identify the main vessel causing transverse mesocolic tension during the extraction of the surgical specimen or extracorporeal anastomosis and to perform an anatomical description of the SRCV.
Methods: In this cadaveric study, we performed a simulation of right hemicolectomy and anatomical description of the surgical area of the gastrocolic trunk of Henle (SAGCTH), the gastrocolic trunk of Henle (GCTH), and SRCV. The length of the exteriorization of the anastomotic transverse colon (ATC) was measured before and after sectioning the vascular vessel causing the exteriorization tension.
Results: Five fresh cadavers and 12 formalin were dissected. In 100% of the specimens, the SRCV was present and drained in 95% into the GCTH and in 5% directly into the superior mesenteric vein (SMV). In 100% of the specimens, the SRCV caused the tension when extracting the ATC. The mean length of exteriorization of the ATC before and after SRCV section was 7.2 and 10.4 cm in formalin cadavers, meaning a 44% of increment in the length of exteriorization. In fresh cadavers, the mean length of exteriorization increased to 2.7 cm, meaning a 28% of the initial length of exteriorization.
Conclusions: The SRCV is the main cause of tension in the extraction of the surgical specimen after right hemicolectomy. Its high tie increases the length of the ATC exteriorization, in about 3 cm, and could reduce the risk of SMV bleeding during laparoscopic right hemicolectomy and facilitate an extracorporeal anastomosis free of tension.
Databáze: MEDLINE
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