How to reduce the superior mesenteric vein bleeding risk during laparoscopic right hemicolectomy
Por:
Garcia-Granero, A, Sanchez-Guillen, L, Frasson, M, Muriel, JS, Sarrado, EA, Fletcher-Sanfeliu, D, Lorente, BF, Pamies, J, Rubio, JC, Navarro, AAV, Soriano, FM and Garcia-Granero, E
Publicada:
1 feb 2018
Categoría:
Gastroenterology
Resumen:
The superior right colic vein (SRCV) has been proposed as the main cause of superior mesenteric vein bleeding by avulsion during laparoscopic right hemicolectomy. Our objective is to identify the main vessel causing transverse mesocolic tension during the extraction of the surgical specimen or extracorporeal anastomosis and to perform an anatomical description of the SRCV.
In this cadaveric study, we performed a simulation of right hemicolectomy and anatomical description of the surgical area of the gastrocolic trunk of Henle (SAGCTH), the gastrocolic trunk of Henle (GCTH), and SRCV. The length of the exteriorization of the anastomotic transverse colon (ATC) was measured before and after sectioning the vascular vessel causing the exteriorization tension.
Five fresh cadavers and 12 formalin were dissected. In 100% of the specimens, the SRCV was present and drained in 95% into the GCTH and in 5% directly into the superior mesenteric vein (SMV). In 100% of the specimens, the SRCV caused the tension when extracting the ATC. The mean length of exteriorization of the ATC before and after SRCV section was 7.2 and 10.4 cm in formalin cadavers, meaning a 44% of increment in the length of exteriorization. In fresh cadavers, the mean length of exteriorization increased to 2.7 cm, meaning a 28% of the initial length of exteriorization.
The SRCV is the main cause of tension in the extraction of the surgical specimen after right hemicolectomy. Its high tie increases the length of the ATC exteriorization, in about 3 cm, and could reduce the risk of SMV bleeding during laparoscopic right hemicolectomy and facilitate an extracorporeal anastomosis free of tension.
Filiaciones:
Garcia-Granero, A:
Hosp Univ & Politecn La Fe, Colorectal Surg Unit, Valencia, Spain
Sanchez-Guillen, L:
Hosp Univ & Politecn La Fe, Colorectal Surg Unit, Valencia, Spain
Frasson, M:
Hosp Univ & Politecn La Fe, Colorectal Surg Unit, Valencia, Spain
Muriel, JS:
Hosp Univ & Politecn La Fe, Colorectal Surg Unit, Valencia, Spain
Sarrado, EA:
Hosp Univ & Politecn La Fe, Colorectal Surg Unit, Valencia, Spain
Fletcher-Sanfeliu, D:
Hosp Univ Son Espases, Cardiovasc Surg Dept, Palma De Mallorca, Mallorca, Spain
Lorente, BF:
Hosp Univ & Politecn La Fe, Colorectal Surg Unit, Valencia, Spain
Pamies, J:
Hosp Univ & Politecn La Fe, Valencia, Spain
:
Hosp Badalona Germans Trias & Pujol, Barcelona, Spain
Navarro, AAV:
Univ Valencia, Dept Anat & Embryol, Surg Anat Unit, Valencia, Spain
Soriano, FM:
Univ Valencia, Dept Anat & Embryol, Surg Anat Unit, Valencia, Spain
Garcia-Granero, E:
Hosp Univ & Politecn La Fe, Colorectal Surg Unit, Valencia, Spain
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