Neurovasculature of high and low tie ligation of the inferior mesenteric artery

PURPOSE: Controversy exists as to whether a high or low tie ligation of the inferior mesenteric artery (IMA) is the preferred technique in surgeries of the left colon and rectum. This study aims to contribute to the discussion as to which is the more beneficial technique by investigating the neurovasculature at each site. METHODS: Ten embalmed cadaveric donors underwent division of the inferior mesenteric artery at the level of the low tie. The artery was subsequently ligated at the root to render a section of tissue for histological analysis of the proximal (high tie), mid and distal (low tie) segments. RESULTS: Ganglia observed in the proximal end of seven specimens in the sample imply that there would be disruption to the innervation in a high tie procedure. CONCLUSION: This study suggests that a high tie should be avoided if the low tie is oncologically viable

High tie versus low tie in rectal surgery: comparison of anastomotic perfusion

Item does not contain fulltextPURPOSE: Both "high tie" (HT) and "low tie" (LT) are well-known strategies in rectal surgery. The aim of this study was to compare colonic perfusion after HT to colonic perfusion after LT. METHODS: Patients undergoing rectal resection for malignancy were included. Colonic perfusion was measured with laser Doppler flowmetry, immediately after laparotomy on the antimesenterial side of the colon segment that was to become the afferent loop (measurement A). This measurement was repeated after rectal resection (measurement B). The blood flow ratios (B/A) were compared between the HT group and the LT group. RESULTS: Blood flow was measured in 33 patients, 16 undergoing HT and 17 undergoing LT. Colonic blood flow slightly decreased in the HT group whereas the flow increased in the LT group. The blood flow ratio was significantly higher in the LT group (1.48 vs. 0.91; p = 0.04), independent of the blood pressure. CONCLUSION: This study shows the blood flow ratio to be higher in the LT group. This suggests that anastomoses may benefit from better perfusion when LT is performed

Workshop Climate Change: The second IPCC Assessment and Report, impressions and reactions from the Dutch Society

Available from National Research Programme on Global Air Pollution and Climate Change, P.O. Box 1, 3720 BA Bilthoven, fax: +31 30 2744436, e-mail: [email protected] niet beschikbaarResults are described of a workshop held on 2 February 1996 in the Netherlands. The main goal of the workshop was to present the IPCC-findings of the Second Assessment Report to a wide audience of policy makers, scientists, politicians, press, business and NGOs. In the report the questions asked during the workshop are answered by representatives from the institutes involved in this project.SG-NO