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Minerva Chirurgica 2021 Jan 12

DOI: 10.23736/S0026-4733.20.08645-9


Risk of anastomotic bleeding after left colectomy with preservation of inferior mesenteric artery for diverticular disease: preliminary results

Umberto BRACALE 1 , Roberto PELTRINI 1, Maria Michela DI NUZZO 1, Gaia ALTIERI 2, Vania SILVESTRI 1, Pasquale DOLCE 1, Michele D'AMBRA 1, Ruggero LIONETTI 1, Francesco CORCIONE 1

1 Department of Public Health, University of Naples Federico II, Naples, Italy; 2 Department of Medical and Surgical Sciences Università Cattolica del Sacro Cuore, Rome, Italy


BACKGROUND: The inferior mesenteric artery (IMA) preservation in elective laparoscopic left colectomy for diverticular disease may reduce the risk of anastomotic leakage. However, an increased risk of bleeding is assumed. The purpose of this study is to investigate the risk of colorectal anastomosis bleeding, when IMA is resected or preserved during left colectomy.
METHODS: A retrospective review of a prospectively collected database was performed. All patients who underwent elective left colectomy, from December 2018 to September 2020, were included. Patients’ data and clinical information were collected and analyzed. Patients were categorized in two group: IMA resected (IMAR) and IMA preserving (IMA-P) left colectomy. Perioperative outcomes between the two groups were compared.
RESULTS: Sixty-three consecutive patients who underwent left colectomy over a period of three years were enrolled: 42 in IMA-R group and 22 in the IMA-P group. There were no significant differences in demographic and intraoperative characteristics between the two groups, except for patients’ age and primary disease. Six patients (9.37%) developed anastomotic bleeding during recovery, more frequently in the IMA-P than IMA-R group, although the difference is not statistically significative (13.6% and 7.3%; p=0.406). All bleedings were self-limited and only one needed red blood cells transfusion. Using the bioabsorbable staple line reinforcement (BSLR) has proved to be advantageous in preventing anastomotic bleeding in the IMA-P group.
CONCLUSIONS: IMA preserving left colectomy seems to be associated with a higher risk of mostly selflimited anastomotic bleeding during recovery. BSLR seems to be effective in this group of patients.

KEY WORDS: Colonic diverticulitis; Surgical anastomosis; Bleeding; Inferior mesenteric artery

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