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The preservation of the left colic artery (LCA) during rectal cancer resection remains a topic of controversy, and there is a notable absence of robust evidence regarding the outcomes associated with LCA preservation. And the advantages of robotic-assisted laparoscopy (RAL) surgery in rectal resection remain uncertain. The objective of this study was to assess the influence of LCA preservation surgery and RAL surgery on intraoperative and postoperative complications of rectal cancer resection. Patients who underwent laparoscopic (LSC) or RAL with or without LCA preservation resection for rectal cancer between April 2020 and May 2023 were retrospectively assessed. The patients were categorized into two groups: low ligation (LL) which with preservation of LCA and high ligation (HL) which without preservation of LCA. A one-to-one propensity score-matched analysis was performed to decrease confounding. The primary outcome was operative findings, operative morbidity, and postoperative genitourinary function. A total of 612 patients were eligible for this study, and propensity score matching yielded 139 patients in each group. The blood loss of the LL group was significantly less than that of the HL group (54.42 ± 12.99 mL vs. 65.71 ± 7.37 mL, p<0.001). The urinary catheter withdrawal time in the LL group was significantly shorter than that in the HL group (4.87 ± 2.04 d vs. 6.06 ± 2.43d, p<0.001). Anastomotic leakage in the LL group was significantly lower than that in HL group (1.44% vs. 7.91%, p = 0.011). The rate of urinary dysfunction and sexual dysfunction in LL group is both significantly lower than HL group. Blood loss and number of harvested lymph nodes (LNs) of both RAL subgroups in LL and HL groups were significantly more than that in LSC subgroups. The anastomotic leakage in the RAL subgroup of HL group was significantly lower than that in LSC subgroup (0% vs. 14.89%, p = 0.018). LCA preservation surgery for rectal cancer may help reduce the blood loss, urinary catheter withdrawal time, the rate of anastomotic leakage and ileus, and postoperative genitourinary function outcomes. RAL can reduce the probability of blood loss and improve harvest LNs in patients with rectal cancer. [ABSTRACT FROM AUTHOR]

Abstract The preservation of the left colic artery (LCA) during rectal cancer resection remains a topic of controversy, and there is a notable absence of robust evidence regarding the outcomes associated with LCA preservation. And the advantages of robotic-assisted laparoscopy (RAL) surgery in rectal resection remain uncertain. The objective of this study was to assess the influence of LCA preservation surgery and RAL surgery on intraoperative and postoperative complications of rectal cancer resection. Patients who underwent laparoscopic (LSC) or RAL with or without LCA preservation resection for rectal cancer between April 2020 and May 2023 were retrospectively assessed. The patients were categorized into two groups: low ligation (LL) which with preservation of LCA and high ligation (HL) which without preservation of LCA. A one-to-one propensity score-matched analysis was performed to decrease confounding. The primary outcome was operative findings, operative morbidity, and postoperative genitourinary function. A total of 612 patients were eligible for this study, and propensity score matching yielded 139 patients in each group. The blood loss of the LL group was significantly less than that of the HL group (54.42 ± 12.99 mL vs. 65.71 ± 7.37 mL, p

Aim: To compare the ablation techniques' efficacy of endovenous microwave ablation (EMA) combined with high ligation (HL), foam sclerotherapy (FS) and compression therapy (CT) and endovenous laser ablation (EVLA) combined with HL-FS-CT in the treatment of VLUs. Method: 301 consecutive patients with VLUs from 2013 to 2022 in a 3200-bed hospital were intervened by EMA combined with HL-FS-CT and EVLA combined with HL-FS-CT were retrospectively compared. Results: One hundred thirty-four patients underwent EMA+HL-FS-CT and 167 patients underwent EVLA+HL-FS-CT. The primary outcome of the ulcer healing time was 1.45(0.75–1.5) months and 1.86(0.5–2.5) months, respectively, in the two groups (HR for ulcer healing was 1.26, 95% CI [0.96–1.66], p = 0.097). Secondary outcomes included that no significant difference was found in ulcer recurrence and GSV recanalization and complications between the two groups, and the postoperative VCSS and AVVQ were significantly lower than the baseline values in the respective groups (p = 0.0001). Conclusion: EMA+HL-FS-CT and EVLA+HL-FS-CT are both effective at treating VLUs. Both of the two comprehensive treatments were beneficial to the healing of ulcers, but no evidence showed which one was superior in the ulcer healing time. [ABSTRACT FROM AUTHOR]

Background: Life expectancy of patients with rectal cancer is increasing day by day with innovative treatments. Low anterior resection syndrome (LARS), which disrupts the comfort of life in these patients, has become a serious problem. We aimed to evaluate the effect of high ligation (HL) and low ligation (LL) techniques on LARS in rectal cancer surgery performed with the robotic method. Materials and Methods: The data of patients diagnosed with mid-distal rectal cancer between 2016 and 2021 who underwent robotic low anterior resection by the same team in the same center with neoadjuvant chemoradiotherapy were retrospectively evaluated. Patients were divided into two groups as those who underwent HL and LL procedures. Preoperative, 8 weeks after neoadjuvant treatment, 3 and 12 months after ileostomy closure were evaluated. Results: A total of 84 patients (41 HL, 43 LL) were included in the study. There was no statistically significant difference between the demographic characteristics and pathology data of the patients. Although there was a decrease in LARS scores after neoadjuvant treatment, there was a statistically significant difference between the two groups at 3 and 12 months after ileostomy closure (P:.001, P:.015). Conclusions: In patients who underwent robotic low anterior resection, there is a statistically significant difference in the LARS score in the first 1 year with the LL technique compared with that of the HL technique, and the LL technique has superiority in reducing the development of LARS between the two oncologically indistinguishable methods. [ABSTRACT FROM AUTHOR]

Double‑blind/multicenter/randomized trial protocol. Eligibility criteria: age 18-70 yrs; C2-C5 leg varices secondary to the Great Saphenous Vein (GSV) incontinence; GSV size 6-10mm, at 10cm from the Saphenous-Femoral Junction (SFJ); ostial reflux lasting >0.5 sec at duplex ultrasound; negative reflux elimination test; acceptance of the GSV sparing treatment plus partial/total varicose veins removal. Exclusion criteria: non-isolated GSV reflux; district already treated; pregnancy/lactation; impaired walking ability; deep vein thrombosis/insufficiency; severe comorbidities. Participants recruited from 7 Italian tertiary referral centres. Interventions: crossotomy (no SFJ’s tributaries ligation) vs crossectomy. The study aimed to verify if GSV drainage through the SFJ’s tributaries reduces groin/peripheral recurrences. Primary endpoint: 1-year GSV reflux recurrence, positive to the Valsalva maneuver, originating from the SF. Participants equally randomized. Participants, care givers, and those assessing the outcomes blinded to group assignment.

Introduction: Whether high or low ligation of the inferior mesenteric artery (IMA) is optimal for treating sigmoid colon and rectal cancers is controversial. The present study aimed to compare outcomes of high and low ligation of the IMA and determine the adequate extent of IMA lymph node dissection. Methods: Subjects were 455 consecutive stage I–III colorectal cancer patients who underwent curative surgery between 2011 and 2019. We assessed the association between the level of IMA ligation and overall survival and recurrence-free survival (RFS) by propensity score matching analysis. Clinicopathological features of IMA lymph node metastasis and recurrence patterns were analyzed. Results: After propensity score matching, the low ligation group had a significantly worse prognosis than that of the high ligation group for RFS (p = 0.039). Positive IMA lymph nodes were associated with pathological T3 or T4 stage and N2 stage. IMA lymph node recurrences in the high ligation group occurred at the superior left side of the IMA root. In contrast, all recurrences in the low ligation group occurred at the left colic artery bifurcation. Conclusion: High ligation of IMA is oncologically safe. However, even with high ligation, care must be taken to ensure adequate lymph node dissection. [ABSTRACT FROM AUTHOR]

Introduction. Electrical burns are one of the most common causes of burns besides flame burns and scalds. High tension electrical burns lead to greater morbidity and mortality. Active management strategies are required to manage high tension electrical burns. Common epidemiological features and surgical management of wounds are described. Role of high ligation in high tension electrical burns has been described.Purpose. To describe the epidemiology, main features of the presentation and acute management of high tension electrical burns.Materials and methods. This study was done for the duration of 2 months. All patients who were admitted with high tension electrical burns were included in the study. Patients’ demographics, mode of injury, % age of burn areas involved, entry-exit wounds were recorded on the day of admission. Emergency fasciotomy was done in cases of impending gangrenous changes inlimbs to prevent compartment syndrome and peripheral neuropathy. Reconstructive surgeries were done depending on thelocation and depth of burns. Results. 64% patients were below 30 years. The majority of the patients who sustained electric burns were males (82.3%). All the patients were from low and middle socioeconomic status according to the modified kuppuswamy scale. The majority of patients sustained electric contact burns (55.8%). The majority of the patients were unskilled workers working in the fields (94.2%). Surgical treatment of all patients includes fasciotomies in 15 patients, debridement/ amputation in 32 patients, reconstructive surgeries in 42 patients.Conclusion. High tension electrical burns are one of the most common causes of burns, especially in rural areas. Public awareness and compliance with safety standards as well as respect for the potentially deleterious effects of electricity are of utmost essential for avoiding these deadly injuries.

Background: Pulsatile varicose veins of the lower extremities are rare in clinical practice. The indications and therapy for pulsating varicose veins remain unclear, and most cases are managed conservatively, with fewer reports of endovenous approaches. However, the treatment of pulsating varicose veins combined with ulcer bleeding remains unclear in the relevant literature. Case presentation: We report a case of sudden rupture and bleeding from a pulsatile varicose vein with a lower extremity ulcer. The patient was a 74-year-old male with atrial fibrillation, pulmonary hypertension, and tricuspid regurgitation. Emergency compression was first applied to stop the bleeding. Wound cleansing, antimicrobial treatment and bacterial control were performed. Elastic compression stockings (23–32 mmHg) were also prescribed. After a comprehensive duplex ultrasound examination and heart disease evaluation, high ligation of the great saphenous vein, radiofrequency ablation and foam sclerotherapy were performed. After the procedure, the chronic venous insufficiency symptoms improved significantly at the 1-month follow-up, and the ulcer was completely healed by postoperative month 5. The patient had mild lower limb swelling, and no ulcer recurrence was reported during the 18-month follow-up. Duplex scans at the 3- and 18-month follow-ups showed complete obliteration of the treated great saphenous vein. Conclusions: Pulsatile varicose veins with ulcer bleeding are a rare pathological condition. It usually results from reflux from the heart and may also be a consequence of hydraulic transmission dysfunction. We believe that comprehensive duplex ultrasound examination of the peripheral vascular system and complex surgical treatment allow the correction of superficial venous reflux and achieve favorable early and mid-term outcomes.

Vascular approach during elective laparoscopic left colectomy impacts post-operative outcomes. The aim of our study was to evaluate how different approaches impact positively defecatory, urinary and sexual functions and quality of life during elective laparoscopic left colectomy. A prospective non-randomized controlled trial at two tertiary center was conducted. All patients who underwent elective laparoscopic left colonic resection from January 2019 to July 2022 were analyzed. They were divided into two groups based on Inferior Mesenteric Artery (IMA) preservation with distal ligation of sigmoid branches close to a colonic wall for complicated diverticular disease and IMA high tie ligation for oncological disease. Patients were asked to fulfil standardized, validated questionnaires to evaluate pre and post-operative defecatory, urinary and sexual functions and quality of life. Defecatory disorders were assessed by high-resolution anorectal manometry preoperatively and six months after surgery. A total of 122 patients were included in the study. The 62 patients with IMA preservation showed a lower incidence of defecatory disorders also confirmed by manometer data, minor incontinence and less lifestyle alteration than the 60 patients with IMA high tie ligation. No urinary disorders such as incomplete emptying, frequency, intermittence or urgency were highlighted after surgery in the IMA preservation group. Evidence of any sexual disorders remained controversial. The IMA-preserving vascular approach seems to be an effective strategy to prevent postoperative functional disorders. It is a safe and feasible technique especially for diverticular disease. New prospective randomized and highly probative studies are needed to confirm the effectiveness in specific clinical situations. [ABSTRACT FROM AUTHOR]

Background: Varicose veins could be a complicated condition, which may lead to limb swelling, pain, and venous ulcer. Conservative hemodynamic correction of venous insufficiency (CHIVA) has been developed over the past two decades and is currently the second most common surgical procedure for the operative treatment of varicose veins. Endovenous laser treatment of great saphenous vein was approved by FDA in 2002 and short saphenous vein (SSV) was approved in 2003. Endovenous laser ablation (EVLA) is a clinically safe, feasible, and welltolerated technique without scar and allows people to return to their normal daily activities rapidly. Aims And Objectives: To study the surgical management (great saphenous vein [GSV] stripping and perforator ligation) and its outcome and compare the outcome of GSV stripping in case of saphenofemoral junction incompetence and perforator ligation in case of perforator incompetence with the results of endoscopic and endovenous procedurespublished in the literature. Results: The patients with varicose veins were treated with high ligation with stripping followed by foam sclerotherapy and RFA. None of the patients undergoing high ligation with stripping had DVT and recurrence which favors the procedure selection for management. However, high ligation with stripping was associated with tenderness followed by infection. complications were less prevalent and only two patients had tenderness. Similarly, in radiofrequency ablation (RFA), one patient each had recurrences, skin color changes, and tenderness. None of the patients undergoing HL/S and foam sclerotherapy had recurrences. It was found that the duration of hospital days was more with HL/S; the majority had 6 to 8 days duration of hospital days whereas 13 patients had it for 4 days. In RFA, the majority had a duration of hospital days of 2 to 3 days only. Conclusion: open surgical management remains important in the treatment of varicose veins and is usually preferable to endovenous procedures and associated with less morbidity if carried out correctly. [ABSTRACT FROM AUTHOR]

Background It is unclear whether to preserve the left colic artery (LCA) for sigmoidectomy or not in cancer surgery. The objective of this study was to assess the value of preservation of LCA in sigmoidectomy in cancer surgery. Patients and methods A total of 55 patients with rectal and sigmoid cancer were admitted to the Menoufia University Hospital (General Surgery Department) and Al-Azhar University Hospital (General Surgery Department). Patients were randomized into two groups: group A included nonpreservation of LCA (28 patients), and group B included preservation of LCA (27 patients). Our oncologic considerations were the number of apical lymph nodes, overall recurrence, 1-year overall survival (disease-free survival), 30-day postoperative morbidity, 30-day postoperative mortality, anastomotic leakage, and urogenital and defecatory dysfunction. Results In our study, 55 individuals were included (28 received LCA nonpreservation surgery and 27 got LCA preservation surgery). Anastomotic leakage was much lower (3.7%) in the LCA preservation group compared with the nonpreservation group (10.7%). There were no significant differences between the LCA nonpreservation and LCA preservation groups in terms of sexual dysfunction, urine retention, the number of apical lymph nodes, short-term oncologic outcomes, operation time, blood loss, and perioperative morbidity and death. Conclusions LCA preservation revealed less anastomotic leakage than LCA nonpreservation in rectosigmoid cancer surgery. Future large volume carefully crafted randomized controlled studies are required to build solid evidence about this issue. [ABSTRACT FROM AUTHOR]

Aim: This study aims to explore the effects of three techniques on postoperative symptom recurrence and clinical outcome and define the predictors. Material and Methods: A total of 121 patients (63 males, 58 females; mean age: 47.4±11.3 years; range, 32 to 73 years) who underwent stripping (n=45), ligation alone (n=36), or ligation and foam sclerotherapy (2% polidocanol, n=40) for varicosities due to small saphenous vein (SSV) insufficiency between January 2004 and December 2011 were included in the retrospective study. Preoperative and postoperative CEAP (Clinical, Etiological, Anatomical, and Pathophysiological), symptom recurrence, and Doppler findings were evaluated with univariate and multivariate analyses. Results: The mean follow-up was 25.8±20.4 months. The operation type did not have any effect on postoperative symptom recurrence, high CEAP (≥3), or clinical outcomes. Predictor of postoperative symptom recurrence was preoperative high CEAP (p=0.001, relative risk [RR]: 4.8); predictor of high postoperative CEAP was postoperative perforating vein insufficiency (p=0.001, RR: 5.148). In the ligation group, a preoperative SSV diameter >5 mm was predictive for both postoperative symptom recurrence (p=0.039, RR: 7.8) and high postoperative CEAP (p=0.002, RR: 1.901), and preoperative deep vein insufficiency was also predictive for postoperative symptom recurrence (p=0.044, RR: 1.304). In the stripping group, postoperative neuropathy was significant (p=0.041, RR: 4.168). There was no difference in Kaplan-Meier symptom-free survival curves (p=0.651), venous clinical severity scores, or Aberdeen Varicose Vein Questionnaire scores among groups. Conclusion: High ligation is not a good option for patients with large SSV diameters or deep vein insufficiency. High ligation with stripping comes with an increased risk of sural neuropathy. High ligation with foam sclerotherapy should be considered an effective method with the ability of the foam to spread over the branches and microvenous structures. Performing operations before progression to high CEAP classes or greater SSV diameters is considerable. [Turk J Vasc Surg 2022; 31(3.000): 140-7]

BackgroudThe high or low inferior mesenteric artery (IMA) ligation in rectal cancer remains a great debate. This study retrospectively discussed the outcomes of the perioperative period, defecation and urinary function and long-term prognosis in rectal cancer patients with high or low IMA ligation.MethodsThis study enrolled 220 consecutive rectal cancer cases, including 134 with high IMA ligation and 86 with low ligation. A comparison between the two groups was made for anastomotic leakage, low anterior resection syndrome (LARS), international prostate symptom score (IPSS), 5-year disease-free survival (DFS) and 5-year overall survival (OS).ResultsLow-ligation group had a longer operative time, and larger intraoperative blood loss. No significant difference was noted in anastomotic leakage incidence. In multivariable analysis, the male gender and tumor located at the lower rectum were identified as risk factors for anastomotic leakage. No significant differences were observed between groups in their LARS and IPSS questionnaire responses. The high-ligation vs. the low-ligation 5-year OS and DFS were 78.3% vs. 82.4% and 72.4% vs. 76.6%, respectively, which were not statistically different.ConclusionThe ligation level of the IMA had no significant effect on the anastomotic leakage incidence, defecation, urinary function, and long-term prognosis.

Aim: This study aims to explore the effects of three techniques on postoperative symptom recurrence and clinical outcome and define the predictors. Material and Methods: A total of 121 patients (63 males, 58 females; mean age: 47.4±11.3 years; range, 32 to 73 years) who underwent stripping (n=45), ligation alone (n=36), or ligation and foam sclerotherapy (2% polidocanol, n=40) for varicosities due to small saphenous vein (SSV) insufficiency between January 2004 and December 2011 were included in the retrospective study. Preoperative and postoperative CEAP (Clinical, Etiological, Anatomical, and Pathophysiological), symptom recurrence, and Doppler findings were evaluated with univariate and multivariate analyses. Results: The mean follow-up was 25.8±20.4 months. The operation type did not have any effect on postoperative symptom recurrence, high CEAP (≥3), or clinical outcomes. Predictor of postoperative symptom recurrence was preoperative high CEAP (p=0.001, relative risk [RR]: 4.8); predictor of high postoperative CEAP was postoperative perforating vein insufficiency (p=0.001, RR: 5.148). In the ligation group, a preoperative SSV diameter >5 mm was predictive for both postoperative symptom recurrence (p=0.039, RR: 7.8) and high postoperative CEAP (p=0.002, RR: 1.901), and preoperative deep vein insufficiency was also predictive for postoperative symptom recurrence (p=0.044, RR: 1.304). In the stripping group, postoperative neuropathy was significant (p=0.041, RR: 4.168). There was no difference in Kaplan-Meier symptom-free survival curves (p=0.651), venous clinical severity scores, or Aberdeen Varicose Vein Questionnaire scores among groups. Conclusion: High ligation is not a good option for patients with large SSV diameters or deep vein insufficiency. High ligation with stripping comes with an increased risk of sural neuropathy. High ligation with foam sclerotherapy should be considered an effective method with the ability of the foam to spread over the branches and microvenous structures. Performing operations before progression to high CEAP classes or greater SSV diameters is considerable. [ABSTRACT FROM AUTHOR]

Our study aims to evaluateand compare the long-term results of endovenous laser (EVLA) and microwave ablation (EMA) combined with high ligation in treating varicose veins (VVs). A total of 122 patients (150 legs) underwent EMA combined with high ligation, and 127 patients (167 legs) underwent EVLA procedures (980 nm) combined with high ligation in this retrospective study. Outcomes included the Aberdeen Varicose Vein Questionnaire (AVVQ) score, the Venous Clinical Severity Score (VCSS), clinical recurrence of VVs and patient satisfaction duringthe 5-year follow-up.During the 5-year follow-up, patients who underwent the EVLA procedure showed a higher recurrence of VVs than those who underwent the EMA procedure (22.75% vs. 13.33%, P = 0.03, odds ratio (OR): 1.91, 95% confidence interval (CI): 1.06–3.45), especially at the primary site (6% vs. 14.37%, P = 0.01; OR: 2.63; 95% CI: 1.21–5.72). VV recurrence within 3 years was higher in patients who underwent EVLA than in those who underwent the EMA procedure (73.68% vs. 40%, P = 0.01; OR: 4.2; 95% CI: 1.37–12.86). Compared with those at baseline, the AVVQ score, VCSS and EQ-5D score improved significantly at 5 years for patients who underwent either procedure (P

Background: Hydrocele of the canal of Nuck (HCN) is a rare cause of inguinal swelling in women. The optimal surgical procedure for HCN in children remains unclear. To assess the safety and efficacy of laparoscopic percutaneous extraperitoneal closure (LPEC) for HCN in a pediatric population, a retrospective study was conducted. In addition, to clarify the pathogenesis of HCN, we assessed the morphological findings of the internal inguinal ring (IIR). Materials and Methods: We retrospectively analyzed 10 consecutive female patients with HCN who underwent LPEC at our hospital between January 2010 and May 2020. Age, operative time, and complications were recorded. Concerning the findings of the IIR, we classified the morphological features as follows: Type 1 (flat), Type 2 (narrow patent processus vaginalis [PPV] with a peritoneal veil), and Type 3 (widely opening PPV). Results: The median age of patients who underwent LPEC was 3 (1-12) years. Although 2 patients showed contralateral inguinal hernia (IH), there were no cases of ipsilateral IH. All patients showed ipsilateral PPV, and the morphological features of the IIR were mostly classified as Type 3 (70%). In total, 6 of 8 HCN cases without preoperatively diagnosed contralateral IH had contralateral PPV (75%), and all were closed by LPEC. All operations were accomplished laparoscopically, and the postoperative course was uncomplicated, with no recurrences observed during the study period. Conclusions: LPEC is a safe and simple surgical approach to repair the HCN in children with minimal complications. [ABSTRACT FROM AUTHOR]

Background and Objectives: This study aimed to compare the effects of high ligation (HL) versus low ligation (LL) in colorectal cancer surgery. Materials and Methods: We performed a comprehensive search using multiple databases (trial registries and ClinicalTrials.gov), other sources of grey literature, and conference proceedings, with no restrictions on the language or publication status, up until 10 March 2021. We included all parallel-group randomized controlled trials (RCTs) and considered cluster RCTs for inclusion. The risk of bias domains were "low risk," "high risk," or "unclear risk." We performed statistical analyses using a random-effects model and interpreted the results according to the Cochrane Handbook for Systematic Reviews of Interventions. We used the GRADE guidelines to rate the certainty of evidence (CoE) of the randomized controlled trials. Results: We found 12 studies (24 articles) from our search. We were very uncertain about the effects of HL on overall mortality, disease recurrence, cancer-specific mortality, postoperative mortality, and anastomotic leakage (very low CoE). There may be little to no difference between HL and LL in postoperative complications (low CoE). For short-term follow-up (within 6 months), HL may reduce defecatory function (constipation; low CoE). While HL and LL may have similar effects on sexual function in men, HL may reduce female sexual function compared with LL (low CoE). For long-term follow-up (beyond 6 months), HL may reduce defecatory function (constipation; low CoE). There were discrepancies in the effects regarding urinary dysfunction according to which questionnaire was used in the studies. HL may reduce male and female sexual function (low CoE). Conclusions: We are very uncertain about the effects of HL on survival outcomes, and there is no difference in the incidence of postoperative complications between HL and LL. More rigorous RCTs are necessary to evaluate the effect of HL and LL on functional outcomes. [ABSTRACT FROM AUTHOR]

Electric burns constitute 4%-6.5% of all burn cases in the western world and 24.49% in India (1,2). High tension burns often requires limbs amputations, the amputation rate reported in high-tension electrical burn injuries ranges from 10% to 68% (2). Amputations of a limb in electric burn patients require special consideration of high ligation of vessels because of progressive necrosis due to vascular injury and prolonged production of thromboxane with electric burns. High ligation of vessels significantly decreases the secondary haemorrhage chances. We do routinely perform high ligation in all cases of hightension electric burn requiring limb amputation. [ABSTRACT FROM AUTHOR]

Abstract Objective This study aimed to explore the pathological characteristics of lymph nodes around inferior mesenteric artery in rectal cancer and its risk factors and its impact on tumor staging. Methods 485 rectal cancer patients underwent proctectomy surgery were collected in this study. Clinical features of patients, including gender, age, BMI, tumor size, pathological type, differentiation, nerve invasion, lymph nodes, tumor marker, and pathological examinations, were analyzed. Results A total of 485 cases were included in this study. There were 29 cases with IMA-LN metastasis; the metastasis rate was 5.98% (29/485). Positive IMA-LNs were associated with distance from anal verge, CEA, pathological type, differentiation, nerve invasion, T stage, and N stage. Multivariate analysis showed that distance from anal verge, CEA level, differentiation, and T stage were independent risk factors for positive IMA-LNs. Conclusion Distance from anal verge, CEA level, differentiation, and T stage were independent risk factors for positive IMA-LNs. No skip metastasis occurred in IMA-LNs. We should choose the appropriate surgical methods to achieve better oncological results and reduce the incidence of postoperative complications.

Background: Encysted hydrocele of the canal of Nuck (EHCN) is homologous to spermatic cord hydrocele in males. EHCN causes swelling in the inguinal region and should be considered in the differential diagnosis of inguinal hernias and masses in females. Complete excision and internal inguinal ring closure are the recommended treatments for symptomatic EHCN. In this study, we aimed at evaluating the safety and feasibility of laparoscopic hydrocelectomy, as well as age-appropriate procedures for EHCN. Materials and Methods: The medical records of 161 female adults and children, who underwent laparoscopic transabdominal hydrocelectomy from January 2014 to December 2020 at a single institution, were reviewed retrospectively and symptoms, location of EHCN, type of fluid in EHCN, postoperative complications, recurrence, and operating time were analyzed. Laparoscopic hydrocelectomy was performed and the internal inguinal ring was closed with high ligation in children and iliopubic tract repair (IPTR) in adults. Results: Fifty-two pediatric (age 2-11 years) and 109 adult (age 21-51 years) female patients were included. More adult patients had inguinal pain (34.9%, 38/109) compared with children (3.8% 2/52) (P < .001). More EHCNs were located in the inguinal canal than protruding into the abdominal cavity in both groups. Regarding the fluid characteristics, hemorrhagic and inflammatory hydroceles were more common in adults than in children (P < .001). There were no serious complications, neither recurrence nor chronic pain was observed in either group except for a surgical-site hematoma in 1 adult patient. Conclusion: Laparoscopic hydrocelectomy together with additional age-appropriate procedures, including high ligation in children and IPTR in adults, is a safe and feasible method for treating EHCN. [ABSTRACT FROM AUTHOR]

Objectives: The primary treatment for varicose ulcers is to address the underlying cause of venous hypertension, additionally, split-thickness skin transplantation (ST) is an effective option for large ulcers. The aim of this study was to compare the efficacy of venous surgery with or without split-thickness ST in the management of varicose ulcers (diameter ≥6 cm)., Methods: Patients with varicose ulcers between 2013 and 2023 were included in the real-world retrospective cohort study. The endovenous microwave ablation/endovenous laser ablation-high ligation-foam sclerotherapy-compression therapy + ST group (EMA/EVLA-CT-HL-FS + ST) consisted of 32 patients, while the EMA/EVLA-CT-HL-FS group consisted of 48 patients., Results: A difference in ulcer healing time was found between the two groups (the hazard ratio [HR] was 4.4, 95% CI [2.3-8.2], P < 0.0001). However, the healing rate did not differ between the two groups at 6 and 12 months postoperatively., Conclusion: ST has been shown to expedite ulcer healing and ameliorate the symptoms of VVs in the early stages of treatment, while its intermediate to long-term efficacy for ulcer healing and overall patient quality of life may be limited., Competing Interests: Declaration of conflicting interestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: Whether high or low ligation of the inferior mesenteric artery (IMA) is superior in surgery for rectal and sigmoid colon cancers remains controversial. Although several meta-analyses have been conducted, the level of lymph node clearance was poorly defined. We performed a meta-analysis comparing high and low ligation of the IMA for sigmoid colon and rectal cancers, with emphasis on high dissection of the lymph node at the IMA root in all the included studies. Methods: PubMed, MEDLINE, and EMBASE databases were searched to identify relevant articles published until 2020. The patient's perioperative and oncologic outcomes were analyzed. Statistical analysis was performed using the statistical software RevMan version 5.4. Results: A total of 17 studies, including four randomized controlled trials, published between 2011 and 2020 were selected. In total, 1,846 patients received low ligation of the IMA plus high dissection of lymph nodes (LL+HD), and 2,648 patients received high ligation of the IMA (HL). LL+HD was associated with low incidence of anastomotic leakage (p < 0.001), borderline long operative time (p = 0.06), and less yields of total lymph nodes (p = 0.03) but equivalent IMA root lymph nodes (p = 0.07); moreover, LL+HD exhibited non-inferior long-term oncological outcomes. Conclusion: In comparison with HL, LL+HD was an effective and safe oncological procedure for sigmoid colon and rectal cancers. Therefore, to ligate the IMA below the level of the left colic artery with D3 high dissection for sigmoid colon and rectal cancers might be suggested once the surgeons are familiar with this technique. Systematic Review Registration: INPLASY.com , identifier 202190029. [ABSTRACT FROM AUTHOR]

BackgroundWhether high or low ligation of the inferior mesenteric artery (IMA) is superior in surgery for rectal and sigmoid colon cancers remains controversial. Although several meta-analyses have been conducted, the level of lymph node clearance was poorly defined. We performed a meta-analysis comparing high and low ligation of the IMA for sigmoid colon and rectal cancers, with emphasis on high dissection of the lymph node at the IMA root in all the included studies.MethodsPubMed, MEDLINE, and EMBASE databases were searched to identify relevant articles published until 2020. The patient’s perioperative and oncologic outcomes were analyzed. Statistical analysis was performed using the statistical software RevMan version 5.4.ResultsA total of 17 studies, including four randomized controlled trials, published between 2011 and 2020 were selected. In total, 1,846 patients received low ligation of the IMA plus high dissection of lymph nodes (LL+HD), and 2,648 patients received high ligation of the IMA (HL). LL+HD was associated with low incidence of anastomotic leakage (p < 0.001), borderline long operative time (p = 0.06), and less yields of total lymph nodes (p = 0.03) but equivalent IMA root lymph nodes (p = 0.07); moreover, LL+HD exhibited non-inferior long-term oncological outcomes.ConclusionIn comparison with HL, LL+HD was an effective and safe oncological procedure for sigmoid colon and rectal cancers. Therefore, to ligate the IMA below the level of the left colic artery with D3 high dissection for sigmoid colon and rectal cancers might be suggested once the surgeons are familiar with this technique.Systematic Review RegistrationINPLASY.com, identifier 202190029.

Purpose We assessed the oncologic and anastomotic benefits of low ligation of the inferior mesenteric artery (IMA) with additional lymph node (LN) retrieval. Methods We performed a retrospective case-control study between January 2011 and July 2015. All patients underwent curative resection of a primary sigmoid or rectal tumor. We excluded patients with distant metastases at the time of diagnosis. The case group included patients who underwent high ligation of the IMA (high group, HG). The control group included patients who underwent low ligation of the IMA with low group with additional LN retrieval (LGAL). Controls were identified by matching patients based on age (±5 years), sex, tumor location, and final histopathological stage. Finally, each group included 97 patients. Results Clinical characteristics did not significantly differ between groups. The mean number of additional harvested LN was 2.19 (range, 0–11), and one patient in the LGAL had a metastatic LN among the additional harvested LN. The overall morbidity was 22.7% in the HG and 30% in the LGAL (P = 0.257). Anastomotic leakage occurred in 14 patients (14.4%) in the HG and 5 patients (5.2%) in the LGAL (P = 0.030). The mean disease-free survival time in the HG was longer than that in the LGAL (P = 0.008). The mean overall survival (OS) time was 70.4 ± 1.3 months. The mean OS was 63.7 ± 1.6 months in the HG and 69.1 ± 2.6 months in the LGAL (P = 0.386). Conclusion Low ligation of the IMA with additional LN retrieval is technically safe. However, the oncologic effect was better after high ligation of IMA.

Background and Objectives: This study aimed to compare the effects of high ligation (HL) versus low ligation (LL) in colorectal cancer surgery. Materials and Methods: We performed a comprehensive search using multiple databases (trial registries and ClinicalTrials.gov), other sources of grey literature, and conference proceedings, with no restrictions on the language or publication status, up until 10 March 2021. We included all parallel-group randomized controlled trials (RCTs) and considered cluster RCTs for inclusion. The risk of bias domains were “low risk,” “high risk,” or “unclear risk.” We performed statistical analyses using a random-effects model and interpreted the results according to the Cochrane Handbook for Systematic Reviews of Interventions. We used the GRADE guidelines to rate the certainty of evidence (CoE) of the randomized controlled trials. Results: We found 12 studies (24 articles) from our search. We were very uncertain about the effects of HL on overall mortality, disease recurrence, cancer-specific mortality, postoperative mortality, and anastomotic leakage (very low CoE). There may be little to no difference between HL and LL in postoperative complications (low CoE). For short-term follow-up (within 6 months), HL may reduce defecatory function (constipation; low CoE). While HL and LL may have similar effects on sexual function in men, HL may reduce female sexual function compared with LL (low CoE). For long-term follow-up (beyond 6 months), HL may reduce defecatory function (constipation; low CoE). There were discrepancies in the effects regarding urinary dysfunction according to which questionnaire was used in the studies. HL may reduce male and female sexual function (low CoE). Conclusions: We are very uncertain about the effects of HL on survival outcomes, and there is no difference in the incidence of postoperative complications between HL and LL. More rigorous RCTs are necessary to evaluate the effect of HL and LL on functional outcomes.

PurposeTo investigate the relationship between the left trunk of the inferior mesenteric plexus (IMP) and the vascular sheath of the inferior mesenteric artery (IMA) and to explore anatomical evidence for autonomic nerve preservation during high ligation of the IMA in colorectal cancer surgery.MethodsWe evaluated the relationship in 23 consecutive cases of laparoscopic or robotic colorectal surgery with high ligation of the IMA at our institute. Anatomical dissection was performed on 5 formalin-fixed abdominal specimens. A novel anatomical evidence-based operative technique was proposed.ResultsAnatomical observation showed that the left trunk of the IMP was closely connected with the IMA and was involved in the composition of the vascular sheath. Based on anatomical evidence, we present a novel operative technique for nerve-sparing high ligation of the IMA that was successfully performed in 45 colorectal cancer surgeries with no intraoperative complications and satisfactory postoperative urogenital functional outcomes.ConclusionThe left trunk of the IMP is involved in the composition of the IMA vascular sheath. This novel anatomical evidence-based operative technique for nerve-sparing high ligation of the IMA is technically safe and feasible.

Purpose: To investigate the relationship between the left trunk of the inferior mesenteric plexus (IMP) and the vascular sheath of the inferior mesenteric artery (IMA) and to explore anatomical evidence for autonomic nerve preservation during high ligation of the IMA in colorectal cancer surgery. Methods: We evaluated the relationship in 23 consecutive cases of laparoscopic or robotic colorectal surgery with high ligation of the IMA at our institute. Anatomical dissection was performed on 5 formalin-fixed abdominal specimens. A novel anatomical evidence-based operative technique was proposed. Results: Anatomical observation showed that the left trunk of the IMP was closely connected with the IMA and was involved in the composition of the vascular sheath. Based on anatomical evidence, we present a novel operative technique for nerve-sparing high ligation of the IMA that was successfully performed in 45 colorectal cancer surgeries with no intraoperative complications and satisfactory postoperative urogenital functional outcomes. Conclusion: The left trunk of the IMP is involved in the composition of the IMA vascular sheath. This novel anatomical evidence-based operative technique for nerve-sparing high ligation of the IMA is technically safe and feasible. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to explore the pathological characteristics of lymph nodes around inferior mesenteric artery in rectal cancer and its risk factors and its impact on tumor staging. Methods: 485 rectal cancer patients underwent proctectomy surgery were collected in this study. Clinical features of patients, including gender, age, BMI, tumor size, pathological type, differentiation, nerve invasion, lymph nodes, tumor marker, and pathological examinations, were analyzed. Results: A total of 485 cases were included in this study. There were 29 cases with IMA-LN metastasis; the metastasis rate was 5.98% (29/485). Positive IMA-LNs were associated with distance from anal verge, CEA, pathological type, differentiation, nerve invasion, T stage, and N stage. Multivariate analysis showed that distance from anal verge, CEA level, differentiation, and T stage were independent risk factors for positive IMA-LNs. Conclusion: Distance from anal verge, CEA level, differentiation, and T stage were independent risk factors for positive IMA-LNs. No skip metastasis occurred in IMA-LNs. We should choose the appropriate surgical methods to achieve better oncological results and reduce the incidence of postoperative complications. [ABSTRACT FROM AUTHOR]

Objectives: This study aimed to identify the unintended incidents that led to patient injuries (PIs) in the treatment of superficial venous insufficiency (SVI). Methods: PI claims filed with the Finnish Patient Insurance Centre between 2004 and 2017 involving SVI were reviewed. Factors contributing to PI were identified and classified. Results: Eighteen (13.2%) of 136 compensated PIs in the specialty of vascular surgery were related to SVI. Only 4.7% of 383 SVI claims were compensated. The incidence of PIs was 9.9 per 100 000 patients. Fifteen patients had open surgery (83.3%) and three (16.7%) endovenous treatment. Two (11.1%) patients had necrotising fasciitis, four (22.1%) had deep vein injuries and two (11.1%) had a permanent nerve injury. Two (11.1%) patients had retained endovenous material that required surgical removal. Conclusions: PIs were identifiable during all stages of care, perioperative injuries related to open surgery being the most common. [ABSTRACT FROM AUTHOR]

Aim: Surgeons have concerns whether high ligation (HL) of the inferior mesenteric artery (IMA) increases the incidence of anastomotic leakage (AL). This meta‐analysis aimed to evaluate the influence of HL of the IMA on AL compared with low ligation (LL). Methods: PubMed, Embase, Web of Science, Cochrane Central Register of Controlled Trials and ClinicalTrials.gov databases were searched. Randomized controlled trial studies that compared HL with LL of the IMA in anterior resection for rectal cancer and reported AL outcomes were eligible for inclusion. The odds ratios and mean differences were analysed by a random‐effects model. Trial sequential analysis was performed to minimize the risk of random errors. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was used to evaluate the quality of evidence for outcomes. Results: Of the 531 records screened, five randomized controlled trials with 779 patients were selected for analysis. The pooled incidence of AL was 12.1% (95% Cl 7.77–18.26) in the HL group and 9.7% (95% Cl 5.79–15.82) in the LL group (OR 1.20, 95% CI 0.77–1.87, P = 0.42). In trial sequential analysis, the cumulative Z‐score curve exceeded the futility boundary, although the required information size of 1060 had not been reached. The quality of evidence was judged to be high according to the GRADE approach. Conclusions: This meta‐analysis shows that HL of the IMA does not increase the incidence of AL in anterior resection for rectal cancer. [ABSTRACT FROM AUTHOR]

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Abstract Background The ideal level of ligation of the inferior mesenteric artery (IMA) during curative resection of sigmoid colon and rectal cancer is still controversial. The aim of this meta-analysis was to examine the impact of high ligation and low ligation of the IMA on anastomotic leakage, overall morbidity, postoperative mortality, and oncological outcomes in patients undergoing surgery for sigmoid colon and rectal cancer. Methods PubMed, EMBASE, Web of Science, and BioMed Central databases were searched to identify relevant articles published from May 1953 to March 2018. A total of 18 articles (14 non-randomized studies and 4 randomized clinical trials) were identified. Review Manager 5.3 software was used for analysis of data. The pooled odds ratio (OR) and weighted mean difference (WMD), with 95% CI, were calculated using either the fixed effects model or random effects model. Results Of the 5917 patients included in this meta-analysis, 3652 patients underwent low ligation of the IMA and 2265 patients underwent high ligation of the IMA. Anastomotic leakage rate was 9.8% in high ligation patients vs. 7.0% in low ligation patients; the risk of anastomotic leakage was significantly higher in high ligation patients (OR = 1.33; 95% CI 1.10–1.62; P = 0.004). What is more, overall morbidity was also significantly higher in high ligation patients (OR = 1.39; 95% CI, 1.05–1.68; P = 0.05). Postoperative mortality, number of harvested lymph nodes, overall recurrence rate, and 5-year survival rate did not differ significantly between the two groups. Conclusion Low ligation of the IMA during curative resection of sigmoid colon and rectal cancer appears to be associated with lower risk of anastomotic leakage and overall morbidity. However, there was no significant advantage of low ligation over high ligation of IMA in terms of postoperative mortality, the number of harvested lymph nodes, overall recurrence rate, or 5-year survival rate.

Background: In the treatment of distal sigmoid and rectal cancer, the appropriate level for the ligation of the inferior mesenteric artery (IMA) remains unresolved. High ligation divides the IMA proximally at its origin, and low ligation ligates the IMA distal to the origin of left colic artery. We assessed the association of level of ligation in scheduled minimally invasive resection of sigmoid and rectal cancers on anastomotic leak, postoperative complications, and death within 30 days.Methods: We identified all patients with primary sigmoid and rectal cancer treated with scheduled minimally invasive resection and primary anastomosis between January 2002 and June 2018 using linked institutional and National Surgical Quality Improvement Program databases. We assessed the association of level of ligation with each outcome by fitting individual univariable and multivariable logistic regression models, adjusting for surgical approach, tumor location, neoadjuvant chemoradiotherapy, and Charlson comorbidity index.Results: We included 158 patients treated with high ligation and 123 patients treated with low ligation. Overall, 12 patients had an anastomotic leak requiring intervention within 30 days: 5 in the high ligation group (3.2%, 95% CI 1.4-7.2%) and 7 in the low ligation group (5.7%, 95% CI 2.8-11.3%). There was no association between the level of ligation and anastomotic leak (unadjusted OR 1.85, 95% CI 0.58-6.38; adjusted OR 0.63, 95% CI 0.16-2.55). Similarly, there was no association between the level of ligation and reoperation for anastomotic leak (OR 1.29, 95% CI 0.15-10.9), major complications (Clavien-Dindo III-V; OR 2.22, 95% CI 0.90-5.77), minor complications (Clavien-Dindo I-II; OR 1.51, 95% CI 0.88-2.60), and all complications (OR 1.58, 95% CI 0.94-2.67). No deaths occurred in either group.Conclusions: There was no association of level of ligation of the IMA with anastomotic leak, postoperative complications as a composite, or death. The choice of high or low ligation of the IMA should be made based on technical factors such as length for the creation of a tension-free anastomosis. [ABSTRACT FROM AUTHOR]

Chronic venous insufficiency (CVI) is defined as a condition affecting the venous system of lower extremities. Different treatment options are used for the treatment of this pathological condition, which impairs quality of life, especially in later stages. Surgical options are used in the case of failure with conservative treatment and pharmacological methods. There are numerous surgical techniques used in the treatment of venous insufficiency. Each of these techniques has its advantages and disadvantages. New hybrid methods are being developed to overcome adverse effects and possible complications such as deep vein thrombosis, phlebitis, and infections. In the present study, we aimed to present the preliminary results of a combination of percutaneous embolization of SV with n-butyl cyanoacrylate (NBCA) and high ligation, which is a novel modified method that we have developed. A total of 47 patients, aged between 28 and 62 years and diagnosed with chronic venous insufficiency, were included in the study. The patients were evaluated with a Comprehensive Classification System For Chronic Venous Disorders, and Venous Clinical Severity Score (VCSS). Patients' demographic features such as age and gender, and clinical features such as CEAP classes, VCSSs, and vena saphena magna VSM diameters were recorded. All patients were treated with a novel modified hybrid technique including Venablock embolization system (Invamed RD, Ankara, Turkey) and surgical high ligation of the greater SV. In addition, patients' preprocedural, intraprocedural, and postprocedural period follow-up data were recorded and retrospectively analyzed. According to the CEAP classification, 38 patients (80.8%) were classified as C3, six patients (12.8%) as C4, and three patients (6.4%) as C2. CEAP class was C3 in majority (38/47) of the patients, with 22 (46.8%) female and 22 (53.2%) male patients in C3 class. The mean preoperative VCSS of the patients was calculated as 8.83 ± 1.31 and the mean postoperative VCSS was calculated as 2.85 ± 0.71. The mean postoperative VCSS was statistically significantly lower than the mean preoperative VCSS (p < 0.05). The technical success rate was found as 100%. None of the patients developed complications or side effects. We suggest that this novel method is efficient and safe in the treatment of chronic venous insufficiency because it eliminates the need for general anesthesia with short operation time and adhesion of all branches of the saphenous vein, thus preventing possible complications. [ABSTRACT FROM AUTHOR]

Purpose: We compared the complication rates and oncologic and functional outcomes of high versus low ligation of the inferior mesenteric artery (IMA). Methods: We reviewed data retrospectively from 776 patients, divided into high and low IMA ligation groups. Low ligation was performed with lymph node dissection around the IMA root. Postoperative complications and oncologic and functional outcomes were analyzed. Results: There were 613 patients in the high ligation group and 163 patients in the low ligation group. Most clinicopathological variables were similar. There were no significant differences in complication rates (25.1% vs. 28.8%; p = 0.336), anastomotic leakage (2.8% vs. 2.5%; p = 1.000), colonic ischemia (2.8% vs. 1.2%; p = 0.393), 5-year overall survival (79.6% vs. 81.3%; p = 0.137) or 5-year relapse-free survival (77.4% vs. 73.3%; p = 0.973) between the groups. In terms of functional outcomes, both techniques were equivalent. The International Prostate Symptom Score and Fecal Incontinence Severity Index were significantly better in the low ligation group 12 months postoperatively than 3 months postoperatively. Conclusions: The oncologic and functional outcomes, as well as postoperative complications, after low ligation of the IMA with lymph node dissection are not significantly different from those after high ligation of the IMA. [ABSTRACT FROM AUTHOR]

To assess the efficacy and safety of endovenous laser treatment (EVLT) and high ligation (HL) for limb varicosity using meta‐analysis. Multiple databases including PubMed, Springer, Excerpta Medica Database, Ovid Technologies, and China Journal Full‐text database were searched for relevant studies in English or Chinese, and full‐text articles were used to compare EVLT and HL for limb varicosity. Review Manager 5.0 was used to estimate the effects of the results among eligible articles. Forest plots, sensitivity analysis, and bias analysis of the included articles were also conducted. Initial screening yielded 1031 studies, 11 randomised controlled trials involving 1145 limb varicosity patients met the inclusion criteria in this study. The results of the heterogeneity test suggested that intraoperative blood loss mean difference (MD) = −6.31[−9.03, −3.60], P < 0.00001), operative time (MD) = −39.76[−42.27, −37.24], P < 0.00001), rate of complications (odds ratio [OR] = 0.37[0.22, 0.61], P < 0.0001), and recurrence (OR = 0.28[0.16, 0.49], P < 0.0001) were significantly different. Although both EVLT and HL have their own merits and demerits, EVLT is a more effective and safe method to treat limb varicosity. [ABSTRACT FROM AUTHOR]

Background: The aim of this study was to evaluate the midterm clinical outcomes after modified high ligation and segmental stripping of small saphenous vein (SSV) varicosities. Methods: Between January 2010 and March 2013, 62 patients (69 legs) with isolated primary small saphenous varicose veins were enrolled in this study. The outcomes measured were reflux in the remaining distal SSV, the recurrence of varicose veins, the improvement of preoperative symptoms, and the rate of postoperative complications. Results: No major complications occurred. No instances of the recurrence of varicose veins at previous stripping sites were noted. Three legs (4.3%) showed reflux in the remaining distal small saphenous veins. The preoperative symptoms were found to have improved in 96.4% of the cases. Conclusion: In the absence of flush ligation of the saphenopopliteal junction, modified high ligation and segmental stripping of small saphenous vein varicosities with preoperative duplex marking is an effective treatment method for reducing postoperative complications and the recurrence of SSV incompetence.

Background: We aimed to evaluate the safety and adequacy of high vascular ligation in surgery for left-sided colon cancer.Methods: Between 2007 and 2016, hand-assisted laparoscopic surgery was performed on 228 patients for descending or sigmoid colon cancer with high ligation of the inferior mesenteric artery and vein. We collected and prospectively studied demographic, clinical, and long-term outcome results. Complications were assessed with the Clavien-Dindo classification. The 5‑year survival (OS) and 5‑year disease-free survival (DFS) probability rates were calculated using Kaplan-Meier curves.Results: There were 71 (31%) patients with stage I disease, 67 (29.7%) with stage II, 65 (28.4%) with stage III, and 25 (10.9%) with stage IV. The average harvested lymph node count was 16.5 ± 10 (range, 10-90). Length of postoperative hospital stay was 6.3 ± 3.2 days (range, 1-30). Eleven (4.82%) patients had complications, and three of them (1.3%) were re-operated. There was no anastomotic leakage detected in our group of patients. The five-year OS of all stages using Kaplan-Meier curves was 0.75 and the DFS was 0.8.Conclusion: Our data support the opinion that high vascular ligation while performing surgery for left-sided colon cancer is safe. Long-term oncological outcomes were similar to those presented in other studies. [ABSTRACT FROM AUTHOR]

Background: Colorectal cancer surgery includes "high tie" and "low tie"of the inferior mesenteric artery(IMA). However, different ligation level is closely related to the blood supply of anastomosis, which may increase the leakage rate, and it is unclear which technique confers a lower anastomotic leakage rate(AL) and survival advantage.Objective: To compare the effectiveness and impact of inferior mesenteric artery (IMA) high ligation versus IMA low ligation on anastomotic leakage, lymph nodes yield rates and 5-year survival.Methods: A list of these studies, published in English from 1990 to 2017, was obtained independently by two reviewers from databases such as PubMed, Medline, ScienceDirect and Web of Science. Anastomotic leakage rate, the yield of lymph nodes and 5-year survival were compared using Review Manager 5.3.Results: There was no significant difference in anastomotic leakage, number of lymph nodes retrieved and 5-year survival rate for both techniques.Conclusions: Neither the high tie nor the low tie strategy has an evidence in terms of anastomotic leakage rate, harvested lymph nodes, and the 5-year survival rate. Further RCT is needed. [ABSTRACT FROM AUTHOR]