Preservation of the inferior mesenteric artery in colorectal resection forcomplicated diverticular disease

Background: Preservation of the inferior mesenteric artery (IMA) and conseq uential blood flow to the rectum would reduce the risk of leakage of a colo rectal anastomosis. Methods: One hundred and sixty-three patients undergoing left colectomy for complicated diverticular disease of the colon were randomly placed into tw o groups: A, n = 86; and B, n = 77. In group A, the integrity of the IMA wa s preserved by artery skeletization (IMAS); in group B, the IMA was divided at its origin. Variables recorded included duration of the surgical proced ure, need for blood transfusion, length C, of hospital stay, operative mort ality and morbidity, staple-ring disruption, and radiologic and clinical le akage. Anastomotic stenosis and recurrence of diverticular disease were not ed. Results: Surgical time was superior in the IMAS group. Radiologic and clini cal leakages were significantly higher in group B (P = 0.02, P = 0.03, resp ectively). In group A a significant lower number of staple-ring disruptions was observed, evolving into clinical dehiscence. Conclusion: Preserving the natural blood supply to the rectum and the ensui ng use of a healthy well-nourished rectal stump are suggested as the main a spects of IMAS in preventing and healing leakage of colorectal anastomosis. (C) 2001 Excerpta Medica, Inc. All rights reserved.