Preservation of the inferior mesenteric artery in laparoscopic nerve-sparing colorectal surgery for endometriosis

Abstract

Laparoscopic rectosigmoid resection for endometriosis is usually performed with the section of the inferior mesenteric artery (IMA) distal to the left colic artery (low-tie ligation). This study was to determine outcomes in IMA-sparing surgery in endometriosis cases. A single-center retrospective study based on the analysis of clinical notes of women who underwent laparoscopic rectosigmoid segmental resection and IMA-sparing surgery for deep infiltrating endometriosis with bowel involvement between March the 1st, 2018 and February the 29th, 2020 in a referral hospital. During the study period, 1497 patients had major gynecological surgery in our referral center, of whom 253 (17%) for endometriosis. Of the 100 patients (39%) who had bowel endometriosis, 56 underwent laparoscopic nerve-sparing rectosigmoid segmental resection and IMA-sparing surgery was performed in 53 cases (95%). Short-term complications occurred in 4 cases (7%) without any case of anastomotic leak. Preservation of the IMA in colorectal surgery for endometriosis is feasible, safe and enables a tension-free anastomosis without an increase of postoperative complication rates.

Vascular‐ and nerve‐sparing bowel resection for deep endometriosis: A retrospective single‐center study

“…Hypothetically, the preservation of the SRA makes it possible to reduce the risk that potentially arises from hypoperfusion of the proximal stump of the rectum, due to a marginal artery of Drummond (anastomosis between the sigmoid arteries and the SRA) that is, for example, insufficient for the anastomosis requirement 9 . However, there is no adequate evidence to establish its superiority compared with the classic technique 8 …”

“…In particular, the section of the inferior mesenteric artery (IMA) distal to the left colic artery is usually performed in order to provide tension‐free anastomosis 8,9 . In any case, besides the increasing use of nerve‐sparing techniques for the treatment of DE with bowel involvement, several authors have recently pointed out the potential benefits of preserving the superior rectal artery (SRA) by preserving the IMA, thus ensuring better perfusion of the anastomosis 8,9 . However, data findings are still heterogeneous and not sufficient to confirm a real advantage for a nerve‐ and vascular‐sparing technique over others 8 .…”

“…8,9 In any case, besides the increasing use of nervesparing techniques for the treatment of DE with bowel involvement, several authors have recently pointed out the potential benefits of preserving the superior rectal artery (SRA) by preserving the IMA, thus ensuring better perfusion of the anastomosis. 8,9 However, data findings are still heterogeneous and not sufficient to confirm a real advantage for a nerve-and vascular-sparing technique over others. 8As such, the aim of our study was to evaluate the complication rates and functional outcomes of a bowel resection technique for DE involving a nerve-and vascular-sparing approach.…”