Variant anatomy of the inferior mesenteric artery and its significance when choosing the level of ligation. Literature review

Introduction. In colorectal cancer surgery, high ligation of the inferior mesenteric artery (IMA) is the "gold" standard. Low ligation of the IMA can decrease the frequency of anastomotic leakage.Aim: to study the variant anatomy of the IMA and determine its significance when choosing the level of ligation.Materials and methods. The research is based on the PubMed and eLIBRARY articles, 30 of which are included in the final review and analysis.Results. In practice, the classification of Yada-Murono is of the greatest interest, according to which there are 4 types of the IMA anatomy: type I - left colic artery (LCA) emanates from IMA independently; type II - LCA and sigmoid artery (SA) co-trunk; type III - LCA, SA and superior rectal artery (SRA) emanate from the same point; type IV - LCA is absent.Discussion. Preservation of the LCA in patients with type I does not cause difficulties for the surgeon. With type II, low ligation due to a short IMA can cause tension of the anastomosis area and the development of anastomotic leakage. For patients with type III, preserving LCA is necessary because high ligation is accompanied by hypoperfusion and more frequent anastomotic leakages. For patients with type IV, the search for LCA is associated with the risk of damaging neighboring structures.Conclusion. Assessment of the IMA anatomy and its branches is of practical importance in colorectal cancer surgery in order to choose the optimal level of its ligation.