Sigmoid resection for diverticular disease - to ligate or to preserve the inferior mesenteric artery? Results of a systematic review and meta-analysis

Colorectal Dis. 2019 Jun;21(6):623-631. doi: 10.1111/codi.14547. Epub 2019 Jan 28.


Aim: In colorectal cancer, ligation of the inferior mesenteric artery (IMA) is a standard surgical approach. In contrast, ligation of the IMA is not mandatory during treatment of diverticular disease. The object of this meta-analysis was to assess if preservation of the IMA reduces the risk of anastomotic leakage.

Method: A search was performed up to August 2018 using the following electronic databases: MEDLINE/PubMed, ISI Web of Knowledge and Scopus. The measures of treatment effect utilized risk ratios for dichotomous variables with calculation of the 95% CI. Data analysis was performed using the meta-analysis software Review Manager 5.3.

Results: Eight studies met the inclusion criteria and were included in the meta-analysis: two randomized controlled trials (RCTs) and six non-RCTs with 2190 patients (IMA preservation 1353, ligation 837). The rate of anastomotic leakage was higher in the IMA ligation group (6%) than the IMA preservation group (2.4%), but this difference was not statistically significant [risk ratio (RR) 0.59, 95% CI 0.26-1.33, I2 = 55%]. The conversion to laparotomy was significantly lower in the IMA ligation group (5.1%) than in the IMA preservation group (9%) (RR 1.74, 95% CI 1.14-2.65, I2 = 0%). Regarding the other outcomes (anastomotic bleeding, bowel injury and splenic damage), no significant differences between the two techniques were observed.

Conclusion: This meta-analysis failed to demonstrate a statistically significant difference in the anastomotic leakage rate when comparing IMA preservation with IMA ligation. Thus, to date there is insufficient evidence to recommend the IMA-preserving technique as mandatory in resection for left-sided colonic diverticular disease.

Keywords: Left-sided diverticular disease; ligation/preservation of inferior mesenteric artery; sigmoid resection.

Publication types

  • Meta-Analysis
  • Systematic Review

MeSH terms

  • Adult
  • Aged
  • Anastomotic Leak / epidemiology
  • Anastomotic Leak / etiology
  • Colectomy / adverse effects
  • Colectomy / methods*
  • Colon, Sigmoid / surgery*
  • Diverticulum, Colon / surgery*
  • Female
  • Humans
  • Ligation / adverse effects
  • Ligation / methods*
  • Male
  • Mesenteric Artery, Inferior / surgery*
  • Middle Aged
  • Non-Randomized Controlled Trials as Topic
  • Randomized Controlled Trials as Topic
  • Treatment Outcome