Division of Colorectal Surgery, Department of Surgery, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea.
Division of Colorectal Surgery, Department of Surgery, Westmead Hospital, University of Sydney Westmead Clinical School, Sydney, New South Wales, Australia.
Dis Colon Rectum. 2018 Mar;61(3):411-414. doi: 10.1097/DCR.0000000000000995.
The Arc of Riolan is a strategic vessel that provides collateral mesenteric circulation in 10% of individuals. The importance of identifying and preserving the arc of Riolan in reducing the risk of ischemia to the proximal anastomotic segment after high ligation anterior resection was evaluated.
The arc of Riolan is a vessel that crosses anterior to the inferior mesenteric vein horizontally below the level of the pancreas. A retrospective review of all recorded videos of laparoscopic and robotic low and ultra-low anterior resections was performed in September to December 2012 and prospective evaluation in April to July 2013. The main outcome measures were arc of Riolan identification and preservation, and this was correlated with postoperative transmural colonic ischemia requiring surgical reintervention. From July 2013 onward, we routinely performed arc of Riolan-sparing anterior resections.
Arc of Riolan was observed in 17.8% of cases. Between 2006 and 2012, before routinely looking for and preserving the arc of Riolan, our rate of acute colonic transmural ischemia requiring an emergency Hartmann procedure after anterior resection was 0.8% (6/723). Between 2012 and 2016, after we started performing arc of Riolan-sparing splenic flexure takedown, there were no cases of acute colonic transmural ischemia requiring surgical reintervention (0/576) after anterior resection.
Recognizing and preserving the arc of Riolan, if visualized, during high inferior mesenteric vein ligation and splenic flexure takedown may be an important step in reducing the risk of acute colonic ischemia postanterior resection. See Video at http://links.lww.com/DCR/A535.
Riolan 弓是一种战略血管，为 10%的个体提供侧支肠系膜循环。评估了在高结扎前切除术后面近端吻合段缺血风险降低时识别和保留 Riolan 弓的重要性。
Riolan 弓是一种在胰腺下方水平横过肠系膜下静脉前方的血管。2012 年 9 月至 12 月对所有腹腔镜和机器人低位和超低位前切除术的记录视频进行了回顾性分析，并于 2013 年 4 月至 7 月进行了前瞻性评估。主要观察指标为 Riolan 弓的识别和保留，并与术后需要手术再干预的穿透性结肠缺血相关。自 2013 年 7 月起，我们常规进行保留 Riolan 弓的前切除术。
17.8%的病例观察到 Riolan 弓。在 2006 年至 2012 年期间，在常规寻找和保留 Riolan 弓之前，我们在前切除术后面急性穿透性结肠缺血需要紧急 Hartmann 手术的发生率为 0.8%（6/723）。在 2012 年至 2016 年期间，在开始进行保留 Riolan 弓的脾曲游离术之后，在前切除术后面没有发生需要手术再干预的急性穿透性结肠缺血（0/576）。
在高肠系膜下静脉结扎和脾曲游离时识别和保留 Riolan 弓（如果可见），可能是降低前切除术后面急性结肠缺血风险的重要步骤。
