Preservation of inferior mesenteric artery reduces short- and long-term defecatory dysfunction after laparoscopic colorectal resection for diverticular disease: An RCT

BackgroundThe quality of life after surgery for diverticular disease is mainly linked to the presence and severity of postoperative defecatory disorders. These symptoms are frequently related to the sigmoid and rectal denervation following the arterial ligation. The preservation of Inferior Mesenteric Artery performing colorectal resections seems to reduce denervation, which led to a better defecatory function. This study aimed to assessing the efficacy of inferior mesenteric artery preservation following colonic resections for diverticular disease in terms of reduced defecatory disorders and improved quality of life.MethodsThis is a prospective randomized controlled trial entirely conducted at St. Maria Goretti and St. Andrea Hospitals. Between January 2012 and January 2018 each patient scheduled for sigmoidectomy, left colonic or rectal resection for diverticular disease were included in the study and randomly divided in two groups. Colorectal resections were performed either preserving the inferior mesenteric artery or not. The incurrence of defecatory disorders and their impact on QoL of defecatory disorders were assessed with 6 questionnaires, administered at 6 and12 months and after 6 years from surgery and with an anorectal manometry performed after 6 months and 5 years.Results219 patients were evaluated during the study showing a statistically lower incidence and severity of defecatory disorders in the group of patients whose inferior mesenteric artery was preserved. These defecatory disorders remained stable over the time. The study showed a statistically better quality of life in patients who experienced less defecatory disorders.ConclusionInferior Mesenteric Artery preserving in colonic resection for diverticular disease allows to improve defecatory function by reducing the denervated colonic tract. This led to better quality of life and less impairment of daily activities also after 6 years from surgery.The study was registered in ClinicalTrials.gov with number NCT06506552.ConclusionInferior Mesenteric Artery preserving in colonic resection for diverticular disease allows to improve defecatory function by reducing the denervated colonic tract. This led to better quality of life and less impairment of daily activities also after 6 years from surgery.The study was registered in ClinicalTrials.gov with number NCT06506552.