Does inferior mesenteric artery ligation affect outcome in elective colonic resection for diverticular disease?

Nardi, Paola De; Gazzetta, Paolo

doi:10.1111/ans.14724

Cited by 8 publications

(18 citation statements)

References 22 publications

(23 reference statements)

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“…The methodological evaluation of the non‐RCTs with the MINORS scale showed that two studies scored 21 points (high quality) , two had 17 points and the other two studies scored 10 points (poor quality) (Appendix ). In the non‐RCTs there was a possible selection bias associated with the decision to preserve or to ligate the IMA.…”

Section: Resultsmentioning

confidence: 99%

“…The electronic search strategy identified 145 citations. After the initial screening of the titles and abstracts and removal of duplications, 58 titles remained, of which 15 were considered relevant [16][17][18][19][20][21][22][23][24][25][26][27][28][29][30]. A total of eight studies met the inclusion criteria and were included in the analysis [16][17][18][19][20][21][22][23] and seven studies were excluded [24][25][26][27][28][29][30] (see Appendix S1 in the online Supporting Information).…”

Section: Results Of the Searchmentioning

confidence: 99%

“…The level of IMA ligation was reported in five studies (680 patients): three studies reported high ligation (410 patients, 60.3%), one study reported low ligation (157 patients, 23.1%) and one study reported a mixture of high and low ligation (113 patients, 16.6%) ( Table 2).…”

Section: Characteristics Of the Studiesmentioning

confidence: 99%

“…The methodological evaluation of the non-RCTs with the MINORS scale showed that two studies scored 21 points (high quality) [18,19], two had 17 points [20,23] and the other two studies scored 10 points Table 1 Characteristics of studies included in the meta-analysis.…”

Section: Risk Of Bias In Included Studiesmentioning

confidence: 99%

“…There was heterogeneity regarding the inclusion/exclusion criteria: three studies excluded the emergency setting [17,18,23] whereas in the other studies [19][20][21][22] some of the included patients had emergency resections (Appendix S5). The definition of anastomotic leakage (clinical versus radiological) was reported in five studies (Appendix S6).…”

Section: Risk Of Bias In Included Studiesmentioning

confidence: 99%

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Sigmoid resection for diverticular disease – to ligate or to preserve the inferior mesenteric artery? Results of a systematic review and meta‐analysis

et al. 2019

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Aim In colorectal cancer, ligation of the inferior mesenteric artery (IMA) is a standard surgical approach. In contrast, ligation of the IMA is not mandatory during treatment of diverticular disease. The object of this meta‐analysis was to assess if preservation of the IMA reduces the risk of anastomotic leakage. Method A search was performed up to August 2018 using the following electronic databases: MEDLINE/PubMed, ISI Web of Knowledge and Scopus. The measures of treatment effect utilized risk ratios for dichotomous variables with calculation of the 95% CI. Data analysis was performed using the meta‐analysis software Review Manager 5.3. Results Eight studies met the inclusion criteria and were included in the meta‐analysis: two randomized controlled trials (RCTs) and six non‐RCTs with 2190 patients (IMA preservation 1353, ligation 837). The rate of anastomotic leakage was higher in the IMA ligation group (6%) than the IMA preservation group (2.4%), but this difference was not statistically significant [risk ratio (RR) 0.59, 95% CI 0.26–1.33, I2 = 55%]. The conversion to laparotomy was significantly lower in the IMA ligation group (5.1%) than in the IMA preservation group (9%) (RR 1.74, 95% CI 1.14–2.65, I2 = 0%). Regarding the other outcomes (anastomotic bleeding, bowel injury and splenic damage), no significant differences between the two techniques were observed. Conclusion This meta‐analysis failed to demonstrate a statistically significant difference in the anastomotic leakage rate when comparing IMA preservation with IMA ligation. Thus, to date there is insufficient evidence to recommend the IMA‐preserving technique as mandatory in resection for left‐sided colonic diverticular disease.

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Section: Resultsmentioning

confidence: 99%

Section: Results Of the Searchmentioning

confidence: 99%

Section: Characteristics Of the Studiesmentioning

confidence: 99%

Section: Risk Of Bias In Included Studiesmentioning

confidence: 99%

Section: Risk Of Bias In Included Studiesmentioning

confidence: 99%

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Sigmoid resection for diverticular disease – to ligate or to preserve the inferior mesenteric artery? Results of a systematic review and meta‐analysis

et al. 2019

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Colonic Diverticular Disease

Hall

Bemelman²

2021

The ASCRS Textbook of Colon and Rectal Surgery

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Our understanding of the pathophysiology of diverticular disease is evolving.• Many behavioral and environmental factors may influence the development of diverticular disease. • Some patients with early uncomplicated diverticulitis can be treated without antibiotics. • The decision to perform elective surgery after several episodes of recurrent uncomplicated diverticulitis should be individualized. • The decision to perform elective surgery after successful non-operative management of a diverticular abscess should be individualized. • Laparoscopic lavage can be employed in some patients with Hinchey III diverticulitis. • Minimally invasive surgery is an acceptable option for managing diverticulitis and its complications.

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Elective Surgery

Binda¹,

Amato²,

Schultz

2022

Colonic Diverticular Disease

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Does inferior mesenteric artery ligation affect outcome in elective colonic resection for diverticular disease?

Abstract: No differences were observed in surgical outcome in IMA ligation and preservation groups, particularly preservation or ligation of the IMA did not affect leakage rate.

Cited by 8 publications

References 22 publications

Sigmoid resection for diverticular disease – to ligate or to preserve the inferior mesenteric artery? Results of a systematic review and meta‐analysis

Sigmoid resection for diverticular disease – to ligate or to preserve the inferior mesenteric artery? Results of a systematic review and meta‐analysis

Colonic Diverticular Disease

Elective Surgery

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