Improvement of Anorectal Function While Preserving of Inferior Mesenteric Artery Performing Left Hemicolectomy for Diverticulosis

Study Overview
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Brief Summary
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The aim of the study is to evaluate the anorectal function after hemicolectomy if we preserve or not the Inferior Mesenteric Artery (IMA). This study wants to demonstrate that IMA preservation could improve patient's quality of life reducing incontinence and/or constipation rate.

Official Title
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Effect of Inferior Mesenteric Artery Preservation Performing Left Hemicolectomy for Diverticulosis in the Anorectal Function

Conditions
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Defecatory Disorders After Left Colonic or Rectal Resection

Intervention / Treatment
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* Procedure: Inferior Mesenteric Artery Preservation
* Procedure: Inferior Mesenteric Artery Ligation


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Age from 18 to 80 years BMI<35 Presence of symptomatic diverticular disease ASA I-III Exclusion Criteria: age > 80 years BMI>35 ASA IV Hinchey III-IV Past performed procedure that could be modify the nervous pattern (i.e. colorectal surgery, left nephrectomy, hysteroannessectomy)

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 80 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Inferior Mesenteric Artery Preservation<br>Performing left hemicolectomy the IMA was preserved ligating close to the colonic wall the sigmoids arteries. | Procedure: Inferior Mesenteric Artery Preservation<br>* Performing left hemicolectomy the IMA was preserved ligating close to the colonic wall the sigmoids arteries.<br>* Other names: IMA-P;|
| Active Comparator: Inferior Mesenteric Artery Ligation<br>Performing left hemicolectomy the IMA is ligated and sectioned after the origin of left colic artery | Procedure: Inferior Mesenteric Artery Ligation<br>* Performing left hemicolectomy the IMA is ligated and sectioned after the origin of left colic artery<br>* Other names: IMA-L;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change from preoperative time in anorectal function | We evaluate the presence of modification in anorectal function respect to the preoperative time. This is assessed with specific questionnnaires and anorectal manometry | 6 and 12 months | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Constipation | We evaluate with a questionnaire (Constipation scoring system) the presence of postoperative constipation | 6 and 12 months | 
| Incontinence | We evaluate with a questionnaire (Continence scale), anorectal manometry and eventually with endoanal ultrasonography the precence of incontinence | 6 and 12 months | 
| Quality of life | We evaluate with SF-36 questionnaire the postoperative quality of life | 6 and 12 months | 
| Postoperative complication | We evaluate the presence of postoperative complication such as anastomotic leakage, anastomotic stricture, pneumonia etc. | 1 month |