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Complications of open repair of juxtarenal aortic aneurysm
Published in Sachinder Singh Hans, Mark F. Conrad, Vascular and Endovascular Complications, 2021
A generous midline incision from the xiphoid to the pubis is made and dissected until the peritoneal cavity is entered. It may be necessary to extend the incision cephalad lateral alongside the xiphoid if higher exposure is needed or in emergent situations such as a rupture where immediate supraceliac control is needed. A self-retaining retractor system should then be positioned. We prefer the Omni retractor as the open configuration of the system does not limit the width of exposure. The greater omentum and transverse colon are brought cephalad and packed away in a moistened towel or lap pad on top of the patient's chest. The small bowel should be retracted to the right and packed within a separate moistened towel. The small bowel is gently placed behind a self-retaining retractor, taking care not to compromise the SMA. This exposes the ligament of Treitz, which can be divided along the jejunum to the level of the aorta. Reposition the retractor to allow as much small bowel to be out of the field as possible, and take down the ligament of Treitz with electrocautery, taking care not to injure the bowel. The inferior mesenteric vein is identified and ligated during this dissection. This allows access to the infrarenal aorta, where the overlying retroperitoneal tissue can be dissected free. Depending on how much aorta is needed for an adequate cuff of the proximal anastomosis, an anterior renal vein may need to be mobilized cephalad, with ligation of the gonadal and/or adrenal vein for better exposure.
Intestinal transplantation
Published in Mark Davenport, James D. Geiger, Nigel J. Hall, Steven S. Rothenberg, Operative Pediatric Surgery, 2020
It is critically important to preserve arterial inflow and venous drainage for the remaining native viscera. Except in the event of total eviscerectomy for multivisceral transplantation, the root of the SMA should be preserved in addition to the celiac axis. When the recipient liver is removed and native foregut is left in situ, we perform a portocaval shunt between the end of the native portal vein and the infrahepatic IVC. This allows for decompression of all remnant native foregut viscera, such as the stomach, duodenum, and pancreas. The IVC is then reclamped above the shunt. Where prior abdominal exenteration removes native foregut in the abdomen, including a near-total gastrectomy prior to a multivisceral transplant, the need for a portocaval shunt is obviated. Vasculature of distal colon needs close attention, particularly with respect to the inferior mesenteric vein. The inferior mesenteric artery is easy to identify and preserve. However, the inferior mesenteric vein can be easily injured during completion enterectomy, which will result in significant venous congestion of the left colon. If the inferior mesenteric vein is not preserved, we recommend trimming down native colon to the rectum, with venous drainage to the hemorrhoidal complex.
Clinical Anatomy Related to Laparoscopic Colorectal Surgery
Published in Haribhakti Sanjiv, Laparoscopic Colorectal Surgery, 2020
David N. Naumann, Mark Dilworth, Sharad Karandikar
The venous drainage of the colon largely follows the arterial supply; the ileocolic, right colic, and middle colic veins drain into the superior mesenteric vein (SMV). However, similar to the RCA, the right colic vein is also often absent [2]. The left colic and sigmoid veins drain into the inferior mesenteric vein (IMV). The SMV and IMV ultimately drain into the hepatic portal vein, the latter via the splenic vein.
Pre-, Peri-, and Postoperative Intravenous Ropivacaine versus that of Lidocaine for Analgesia after Hand-Assisted Laparoscopic Surgery of Left Colon Cancer: A Retrospective Analysis
Published in Journal of Investigative Surgery, 2021
Patients were instructed to lay down on the supine position before anesthesia on the bed. A 5.5 cm transumbilical incision was performed by surgeon and laparoscopy port (Phoenix Instruments Inc., Naperville, IL, USA) was inserted. Under the control of the hand, 4.5 cm trocar (Phoenix Instruments Inc., Naperville, IL, USA) was inserted in the left lateral quadrant above and toward the midline from the anterior superior iliac spine and 9.5 cm trocar (Phoenix Instruments Inc., Naperville, IL, USA) was inserted toward the right midclavicular above the umbilicus. A 11.5 cm trocar (Phoenix Instruments Inc., Naperville, IL, USA) was inserted toward the right anterior superior iliac spine. The inferior mesenteric vein and artery mobilized and ligated with the clip (Phoenix Instruments Inc., Naperville, IL, USA). The part of the colon was removed by incision and anastomosis was performed laparoscopically by a double-stapling technique using circular staples. The stitches were took on the skin by a suture (F. Hoffmann-La Roche Ltd, Basel, Switzerland) [1]. All procedures were performed by the general surgeon (minimum 4 years’ experience of laparoscopic colon surgeries) of the institutes. All instruments were USFDA approved.
Difference between right-sided and left-sided colorectal cancers: from embryology to molecular subtype
Published in Expert Review of Anticancer Therapy, 2018
Seung Yoon Yang, Min Soo Cho, Nam Kyu Kim
The endodermal gut tube created by body folding during the fourth week of gestation consists of a blind-ended cranial foregut, a blind-ended caudal hindgut, and a midgut open to the yolk sac through the vitelline duct [11]. The midgut forms the distal duodenum, jejunum, ileum, cecum, ascending colon, and proximal two-thirds of the transverse colon. The hindgut forms the distal third of the transverse colon, the descending and sigmoid colon, and the upper two-thirds of the anorectal canal. Just superior to the cloacal membrane, the primitive gut tube forms an expansion called the cloaca. During the fourth to sixth weeks, a coronal urorectal septum partitions the cloaca into the urogenital sinus, which will give rise to urogenital structures, and a dorsal anorectal canal [12]. As the right and left sides of the colon derive from different embryologic origins, anatomically, the proximal colon receives its main blood supply from the superior mesenteric artery with its capillary network being multilayered. The distal colon is perfused by the inferior mesentery artery. Between these two main sources, there is a watershed area located just proximal to the splenic flexure where branches of the left branch of the middle colic artery anastomose with those of the left colic artery. This area represents the border of the embryologic midgut and hindgut. Venous drainage of the colon largely follows the arterial supply with superior and inferior mesenteric veins draining both the right and left halves of the colon.
Effects of resistance training on liver structure and function of aged rats
Published in The Aging Male, 2018
Ricardo Aparecido Baptista Nucci, Ana Caroline de Souza Teodoro, Walter Krause Neto, Wellington de Assis Silva, Romeu Rodrigues de Souza, Carlos Alberto Anaruma, Eliane Florencio Gama
We can see that the absolute weight of the liver did not change with RT. In order to have no doubts about these results, we performed the relative liver weight, established by the ratio of the total liver weight (absolute weight) divided by the final BW of the animal times 100. Regarding to the relative liver weight (Figure 1(C)), we observed that RT is a factor that decreases liver mass. Additionally, in Figure 2, we suggest, using LPC % and NLP %, that RT may reduce blood flow in the liver. According to van Wijck et al. [16] these results may be related to splanchnic hypoperfusion. Drainage of the splanchnic area is covered by the superior mesenteric vein, inferior mesenteric vein, and the portal vein, which return the venous blood to the heart via the liver and subsequently the inferior vena cava [16,17]. The splanchnic vasculature promotes vasodilatation or constriction via regulation of the mesenteric vascular resistance by neuroendocrine, humoral, and paracrine mechanisms [16,18]. During exercise, the release of norepinephrine near the α-adrenoreceptors of the sympathetic nervous system induces splanchnic vasoconstriction, thereby increasing total splanchnic vascular resistance [16,17,19,20]. The blood is rapidly redistributed from the splanchnic area to be used for the perfusion of tissues with increased activity during exercise, such as heart, lungs, active muscle, and skin [16,21,22].