Dittrich Luca, Ossami Saidy Ramin Raul, Plewe Julius, Hartlage Christa, Raschzok Nathanael, Siegel Robert, Pratschke Johann, Haase Oliver
Department of Surgery, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität, Campus Virchow Klinikum, Campus Charité Mitte, Augustenburger Platz 1, 13353, Berlin, Germany.
Clinician Scientist Program, BIH Academy, Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Berlin, Germany.
Surg Endosc. 2025 Sep 5. doi: 10.1007/s00464-025-12123-3.
High tie ligation of the inferior mesenteric artery (IMA) is the standard technique in oncological low anterior rectal resection. However, high tie may reduce blood flow to the colon, impairing distal tissue perfusion, anastomotic healing, and potentially causing necrosis. Therefore, a modified high tie technique (MoHiTi) was developed that preserves the arterial arc from the left colic artery via the proximal IMA to the first sigmoidal branch.
In this prospective cohort study, all patients with rectal cancer undergoing low anterior resection with TME and a stapled side-to-end anastomosis were included. The arterial arc between the left colic artery, proximal inferior mesenteric artery, and the outgoing first sigmoidal artery branch was preserved. The dissection lines with standard dissection or MoHiTi technique were marked and the gain of length of the proximal colon limb was measured.
Thirty-one patients met the inclusion criteria; two refused participation and in two cases the arcade could not be preserved. Consequently, 27 patients (93%) successfully underwent the MoHiTi procedure. All surgeries were performed as minimally invasive resections with a protective loop ileostomy or transverse colostomy. The major complication rate (Clavien-Dindo ≥ 3) was 18.5%, including one anastomotic leak (3.7%) and three cases of presacral abscess; no ischemia was observed, and no reoperations were required. The modified technique achieved a gain in proximal colon length of 12 cm (range, 10-17 cm).
The MoHiTi modification is feasible, offering an extended colon length that facilitates a better-perfused, tension-free anastomosis.
肠系膜下动脉（IMA）高位结扎是直肠癌低位前切除术的标准技术。然而，高位结扎可能会减少结肠的血流，损害远端组织灌注、吻合口愈合，并可能导致坏死。因此，开发了一种改良的高位结扎技术（MoHiTi），该技术保留了从左结肠动脉经IMA近端到第一支乙状结肠分支的动脉弓。
在这项前瞻性队列研究中，纳入了所有接受经腹会阴联合直肠癌根治术（TME）及吻合器端端吻合的直肠癌患者。保留左结肠动脉、肠系膜下动脉近端和发出的第一支乙状结肠动脉分支之间的动脉弓。标记采用标准解剖或MoHiTi技术的解剖线，并测量近端结肠段的长度增加量。
31例患者符合纳入标准；2例拒绝参与，2例无法保留动脉弓。因此，27例患者（93%）成功接受了MoHiTi手术。所有手术均采用微创切除术，并进行了保护性回肠造口术或横结肠造口术。主要并发症发生率（Clavien-Dindo≥3级）为18.5%，包括1例吻合口漏（3.7%）和3例骶前脓肿；未观察到缺血情况，也无需再次手术。改良技术使近端结肠长度增加了12 cm（范围为10 - 17 cm）。
MoHiTi改良术是可行的，可增加结肠长度，有利于进行血供更好、无张力的吻合。
