Evidence map›Paper›PMID 40913177›Full record

ArticleSurgical endoscopy2025

Modification of the vascular preparation after high tie ligation to improve colonic perfusion and increase the length of the colon limb in low anterior rectal resection.

Luca Dittrich, Ramin Raul Ossami Saidy, Julius Plewe, Christa Hartlage, Nathanael Raschzok, Robert Siegel, Johann Pratschke, Oliver Haase

Erratum issuedAbstract read
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In one paragraph

Article in Surgical endoscopy, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. Cited by 1 paper, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed, 1 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed, 1 synthesis or guideline pooled it.

  1. Pooled it
4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

8 authors.

Luca DittrichDepartment 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. luca.dittrich@charite.de.ORCID http://orcid.org/0000-0002-4711-5214
Ramin Raul Ossami SaidyDepartment 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.
Julius PleweDepartment 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.
Christa HartlageDepartment 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.
Nathanael RaschzokDepartment 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.
Robert SiegelDepartment 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.
Johann PratschkeDepartment 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.
Oliver HaaseDepartment 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.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

introductionHigh 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.

methodsIn 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.

resultsThirty-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).

conclusionThe MoHiTi modification is feasible, offering an extended colon length that facilitates a better-perfused, tension-free anastomosis.

Indexed as

ColonMesenteric Artery, InferiorProctectomyRectal NeoplasmsAdultAgedAged, 80 and overAnastomosis, SurgicalFemaleHumansLigationMaleMiddle AgedPostoperative ComplicationsProspective StudiesMinimal invasive surgeryRectal cancerRectal cancer surgery

Identifiers

PMID40913177

What OpenQuestion holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.