Vascular Anatomy of the Rectal Stump After Total Mesorectal Excision

Nano, M; Marchisio, Filippo; Ferronato, Marco; Breatta, Andrea Doriguzzi; Solej, Mario; Barbero, Stefano; Poli, M. Dei; Gandini, Giovanni

doi:10.1007/s10350-006-0734-8

Cited by 8 publications

(10 citation statements)

References 44 publications

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“…[6]. These vessels are of great importance especially in terms of oncological rectal resections, where those collateral arterial vessels originating from the inferior rectal artery are crucial for sufficient blood supply of the rectal stump [7]. The suggestion by Bursics et al.…”

Section: Discussionmentioning

confidence: 99%

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Anatomical branches of the superior rectal artery in the distal rectum

Schuurman

Bleys

2009

Colorectal Disease

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Section: Discussionmentioning

confidence: 99%

“…Haemorrhoidal artery ligation therapy (HAL/THD) is minimally invasive and produces little pain [7,12,14]. Its aim is to reduce the blood flow to the haemorrhoidal plexus by identifying the arterial branches by ultrasound Doppler probe and ligating them individually.…”

Section: Discussionmentioning

confidence: 99%

Anatomical branches of the superior rectal artery in the distal rectum

Schuurman

Bleys

2009

Colorectal Disease

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“…In some cases, problems of anastomosis can occur due to an abnormality of blood vessels in the distal end, causing venous congestion 21 . However, in general, the distal rectal stump has its own vascularization sustained by the middle and inferior rectal arteries, branches of the internal iliac artery 22 and the possibility of vascular insufficiency of the distal rectum is extremely low in clinical practice. In the study, one experienced surgical assistant who knew the clinical status of patient participated in assessment the perfusion status, and it might be associated with some biases of the results in this study.…”

Section: Discussionmentioning

confidence: 99%

Intraoperative perfusion assessment of the proximal colon by a visual grading system for safe anastomosis after resection in left-sided colorectal cancer patients

Ryu

Lim

Choi

et al. 2021

Sci Rep

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We aimed to evaluate the clinical feasibility of a new visual grading system. We included 50 patients who underwent resection of primary colorectal cancer. Before anastomosis, the marginal vessel was cut and the perfusion status was assessed by a visual grading system. The visual grading system is comprised of five grades according to the bleeding from the marginal vessel and is categorized into 4 groups: good (grade A and B), moderate (grade C), poor (grade D) and none (grade E). Colorectal anastomosis was performed only in the good and moderate groups. We compared postoperative outcomes between the good and moderate groups and analysed the factors affecting the perfusion grade. Among the patients, 48% were grade A, 12% were grade B, and 40% were grade C. There was no anastomotic leakage. Only one patient with grade C showed ischemic colitis and needed reoperation. Age was the only factor correlated with perfusion grade in multivariate analysis (OR 1.080, 95% CI 1.006–1.159, p = 0.034). The perfusion grades were significantly different between > 65 and < 65 year-old patients (> 65, A 29.2% B 12.5% C 58.3% vs. < 65, A 65.4% B 11.5% C 23.1%, p = 0.006). Our intraoperative perfusion assessment that uses a cutting method and a visual grading system is simple and useful for performing a safe anastomosis after colorectal resection. If the perfusion grade is better than grade C, an anastomosis can be performed safely. Age was found to be an important factor affecting the perfusion grade.

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“…Bilhim et al (2013) reported that anastomoses between the MAA and the superior and inferior anorectal arteries were found in 87.5% of cases. Nano et al (2006) reported that the lower rectum is usually vascularized uniformly by the MAA, and therefore, ligation of the inferior mesenteric vascularization would not jeopardize the arterial supply of the rectal stump. Therefore, the MAA could possibly have a greater contribution toward the anorectal arterial vascularization, in juxtaposition to the previous assumptions (Nano et al, 2006).…”

Section: Introductionmentioning

confidence: 99%

“…Nano et al (2006) reported that the lower rectum is usually vascularized uniformly by the MAA, and therefore, ligation of the inferior mesenteric vascularization would not jeopardize the arterial supply of the rectal stump. Therefore, the MAA could possibly have a greater contribution toward the anorectal arterial vascularization, in juxtaposition to the previous assumptions (Nano et al, 2006). On the contrary, Vogel and Klosterhalfen (1988) deemed that the MAA supplies the rectum solely as an accessory vessel.…”

Section: Introductionmentioning

confidence: 99%

The middle anorectal artery: A systematic review and meta‐analysis of 880 patients/1905 pelvic sides

et al. 2022

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The middle anorectal artery (MAA) is considered to supply the middle and lower parts of the rectum, however, its prevalence and point of origin vary across the literature. Clinical importance of the MAA becomes evident in the total mesorectal excision during the colorectal surgery of rectal cancer in both sexes, as well as interventional radiology procedures utilizing the prostatic vasculature in males. Major electronic medical databases were investigated for terms pertaining to the MAA and its associated variations. Compatible data regarding the artery's prevalence, laterality, origin, and distribution in both sexes was acquired. The risk of bias within the studies was assessed utilizing the AQUA tool. In total, 28 works (n = 880 patients/1905 pelvic sides) were included in this systematic review and meta‐analysis, and their publication date ranged from 1897 until 2021. The overall pooled prevalence estimate for the MAA was 59.8% of the patients, and 55.2% of the pelvic sides studied. The vessel was identified more frequently in cadaveric pelvic sides evaluations (79.3%). The artery was found bilaterally more often (56.7%), and most commonly originated from the internal pudendal artery (50.3%). Anastomoses between the MAA and the other anorectal arteries were reported in 78.1%. The MAA is predominantly a present vessel, with various point of origin. Its direct clinical significance is yet to be discovered in larger study samples, providing more detailed and unified reports of its anatomical features, especially regarding its branches.

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Vascular Anatomy of the Rectal Stump After Total Mesorectal Excision

Abstract: The vascularization of the short rectal stump is generally well represented even after total mesorectal excision.

Cited by 8 publications

References 44 publications

Anatomical branches of the superior rectal artery in the distal rectum

Anatomical branches of the superior rectal artery in the distal rectum

Intraoperative perfusion assessment of the proximal colon by a visual grading system for safe anastomosis after resection in left-sided colorectal cancer patients

The middle anorectal artery: A systematic review and meta‐analysis of 880 patients/1905 pelvic sides

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