Comparative Study between High and Low Inferior Mesenteric Artery Ligation in Laparoscopic Total Mesorectal Excision in Rectal Cancer Patients

Introduction: Surgery is the primary treatment for rectal cancer, with laparoscopy improving visualization duringtotal mesorectal excision (TME). There are two techniques for ligating the inferior mesenteric artery (IMA): highligation at its aortic origin and low ligation after branching the left colic artery.Aim of work: The present study aims to evaluate the difference between high and low ligation of the (IMA)regarding healing; vascularity and recurrence after laparoscopic (TME) in cases of rectal cancerPatients and methods: This prospective / retrospective study was conducted on 43 patients with rectal cancerat two tertiary hospitals from January 2014 to December 2017. The patients were divided into two groups: highligation of the inferior mesenteric artery group (HL) (19 cases), and a group that underwent low ligation (LL) ofthe artery (21 cases); another 3 patients underwent a new approach described as functional high ligation (FHL).Retrospective cases were followed up for 4 years postoperatively.Results: Our study revealed no significant difference between the two groups regarding complications. Leakageoccurred in 3 cases with high ligation and 2 cases with low ligation of IMA. Sloughing of the stoma was encounteredin 2 cases done with high ligation and 1 case done with low ligation of IMA. Follow-up revealed 2 cases ofrecurrence; one case in each groupConclusion: No difference was found between high and low ligation of the inferior mesenteric artery in laparoscopictotal mesorectal excision (TME) in cases of cancer rectum regarding complications.