Mesenteric closure with polymer-ligating clips after right colectomy with complete mesocolic excision for cancer and mesentery-based ileocolic resection for Crohn’s disease

Sica, Giuseppe; Franceschilli, Marzia; Sensi, Bruno; Siragusa, Leandro; Vinci, Danilo; Bellato, Vittoria

doi:10.1007/s10151-021-02493-w

Cited by 3 publications

(7 citation statements)

References 28 publications

(29 reference statements)

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“…Table 1 summarizes the data of 175 patients with mesenteric closure from four studies The incidence of postoperative complications varied from 0 to 30% and differences in the range of outcome records and small sample sizes may account for disparities. The difference recorded for the last two studies is quite large, and we suspected that incision infection had not been recorded in Sica et al’s study [ 14 ]. The incidence of post-operative anastomotic leakage was 5% for both studies [ 14 , 16 ].…”

Section: Resultsmentioning

confidence: 90%

“…The difference recorded for the last two studies is quite large, and we suspected that incision infection had not been recorded in Sica et al’s study [ 14 ]. The incidence of post-operative anastomotic leakage was 5% for both studies [ 14 , 16 ]. Only one study gave a 5% reoperation rate [ 14 ] and there were no postoperative deaths, no internal hernias and no mention of complications related to the closure of the mesenteric defects.…”

Section: Resultsmentioning

confidence: 90%

“…Publications from the time period 2009 to 2021 were included, of which 57% were published in the five years from 2016–2021 [ 13 – 16 ]. Three studies from North America [ 5 , 8 , 13 ], one from Asia [ 15 ] and three from Europe were finally selected [ 14 , 16 , 17 ]. All studies used for data extraction were retrospective with “low” quality judged by Modified GRADE quality assessment [ 18 ].…”

Section: Resultsmentioning

confidence: 99%

“…The incidence of post-operative anastomotic leakage was 5% for both studies [ 14 , 16 ]. Only one study gave a 5% reoperation rate [ 14 ] and there were no postoperative deaths, no internal hernias and no mention of complications related to the closure of the mesenteric defects. Serious complications were very rare and deaths did not occur in patients receiving mesenteric closure.…”

Section: Resultsmentioning

confidence: 99%

“…1 ). A lower rate of postoperative complications was found for patients receiving closure but there were many confounding factors and this was a single-institution study [ 14 ]. Thus, the evidence-based demonstration level was not high enough to be convincing.…”

Section: Resultsmentioning

confidence: 99%

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The value of mesenteric closure after laparoscopic right hemicolectomy: a scoping review

Zhou

2023

BMC Surg

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Objective To evaluate the prognostic impact and describe suturing tools of mesenteric closure after laparoscopic right hemicolectomy (LRH). Methods PubMed, Embase, Cochrane library, Web of Science, and Scopus databases, were searched and publications relating to mesenteric closure data and tools were extracted. Search terms: “Mesenteric Defects” and “Mesenteric Closure” were used, and manual searches of eligible articles from literature reference lists performed. Result A total of 7 publications were identified. 5 focused on prognostic impact and 4 referred to tools for mesenteric closure, two of which concerned both prognostic data and tools. All studies related to prognostic impact were single center with “low” modified GRADE quality. A high degree of heterogeneous was found. Conclusion The evidence from current research does not support routine closure of mesenteric defects. Use of a polymer ligation clip has produced favorable results in a small sample size trial and further investigation is merited. A large randomized controlled trial is still warranted.

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Section: Resultsmentioning

confidence: 90%

Section: Resultsmentioning

confidence: 90%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

See 3 more Smart Citations

The value of mesenteric closure after laparoscopic right hemicolectomy: a scoping review

Zhou

2023

BMC Surg

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Gastrointestinal functions after laparoscopic right colectomy with intracorporeal anastomosis: a pilot randomized clinical trial on effects of abdominal drain, prolonged antibiotic prophylaxis, and D3 lymphadenectomy with complete mesocolic excision

Sica,

Siragusa,

Pirozzi

et al. 2024

Int J Colorectal Dis

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Purpose Routine use of abdominal drain or prolonged antibiotic prophylaxis is no longer part of current clinical practice in colorectal surgery. Nevertheless, in patients undergoing laparoscopic right hemicolectomy with intracorporeal anastomosis (ICA), it may reduce perioperative abdominal contamination. Furthermore, in cancer patients, prolonged surgery with extensive dissection such as central vascular ligation and complete mesocolon excision with D3 lymphadenectomy (altogether radical right colectomy RRC) is called responsible for affecting postoperative ileus. The aim was to evaluate postoperative resumption of gastrointestinal functions in patients undergoing right hemicolectomy for cancer with ICA and standard D2 dissection or RRC, with or without abdominal drain and prolonged antibiotic prophylaxis. Methods Monocentric factorial parallel arm randomized pilot trial including all consecutive patients undergoing laparoscopic right hemicolectomy and ICA for cancer, in 20 months. Patients were randomized on a 1:1:1 ratio to receive abdominal drain, prolonged antibiotic prophylaxis or neither (I level), and 1:1 to receive RRC or D2 colectomy (II level). Patients were not blinded. The primary aim was the resumption of gastrointestinal functions (time to first gas and stool, time to tolerated fluids and food). Secondary aims were length of stay and complications’ rate. ClinicalTrials.gov no. NCT04977882. Results Fifty-seven patients were screened; according to sample size, 36 were randomized, 12 for each arm for postoperative management, and 18 for each arm according to surgical techniques. A difference in time to solid diet favored the group without drain or antibiotic independently from standard or RRC. Furthermore, when patients were divided with respect to surgical technique and into matched cohorts, no differences were seen for primary and secondary outcomes. Conclusion Abdominal drainage and prolonged antibiotic prophylaxis in patients undergoing right hemicolectomy for cancer with ICA seem to negatively affect the resumption of a solid diet after laparoscopic right hemicolectomy with ICA for cancer. RRC does not seem to influence gastrointestinal function recovery.

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A novel technique for NO.253 lymph node dissection and left colic artery preservation to avoid potential postoperative internal hernia in laparoscopic radical resection for rectal cancer

Luo,

Li,

Qian

et al. 2024

BMC Surg

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Background The preservation of the left colic artery (LCA) has emerged as a preferred approach in laparoscopic radical resection for rectal cancer. However, preserving the LCA while simultaneously dissecting the NO.253 lymph node can create a mesenteric defect between the inferior mesenteric artery (IMA), the LCA, and the inferior mesenteric vein (IMV). This defect could act as a potential “hernia ring,” increasing the risk of developing an internal hernia after surgery. The objective of this study was to introduce a novel technique designed to mitigate the risk of internal hernia by filling mesenteric defects with autologous tissue. Methods This new technique was performed on eighteen patients with rectal cancer between January 2022 and June 2022. First of all, dissected the lymphatic fatty tissue on the main trunk of IMA from its origin until the LCA and sigmoid artery (SA) or superior rectal artery (SRA) were exposed and then NO.253 lymph node was dissected between the IMA, LCA and IMV. Next, the SRA or SRA and IMV were sequentially ligated and cut off at an appropriate location away from the “hernia ring” to preserve the connective tissue between the “hernia ring” and retroperitoneum. Finally, after mobilization of distal sigmoid, on the lateral side of IMV, the descending colon was mobilized cephalad. Patients’preoperative baseline characteristics and intraoperative, postoperative complications were examined. Results All patients’ potential “hernia rings” were closed successfully with our new technique. The median operative time was 195 min, and the median intraoperative blood loss was 55 ml (interquartile range 30–90). The total harvested lymph nodes was 13.0(range12−19). The median times to first flatus and liquid diet intake were both 3.0 days. The median number of postoperative hospital days was 8.0 days. One patient had an injury to marginal arterial arch, and after mobolization of splenic region, tension-free anastomosis was achieved. No other severe postoperative complications such as abdominal infection, anastomotic leakage, or bleeding were observed. Conclusions This technique is both safe and effective for filling the mesenteric defect, potentially reducing the risk of internal hernia following laparoscopic NO.253 lymph node dissection and preservation of the left colic artery in rectal cancer surgeries.

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Mesenteric closure with polymer-ligating clips after right colectomy with complete mesocolic excision for cancer and mesentery-based ileocolic resection for Crohn’s disease

Cited by 3 publications

References 28 publications

The value of mesenteric closure after laparoscopic right hemicolectomy: a scoping review

The value of mesenteric closure after laparoscopic right hemicolectomy: a scoping review

Gastrointestinal functions after laparoscopic right colectomy with intracorporeal anastomosis: a pilot randomized clinical trial on effects of abdominal drain, prolonged antibiotic prophylaxis, and D3 lymphadenectomy with complete mesocolic excision

A novel technique for NO.253 lymph node dissection and left colic artery preservation to avoid potential postoperative internal hernia in laparoscopic radical resection for rectal cancer

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