Is inferior mesenteric artery ligation during sigmoid colectomy for diverticular disease associated with increased anastomotic leakage? A meta-analysis of randomized and non-randomized clinical trials.

Aim:  A metaanalysis was conducted to compare preservation with ligation of the inferior mesenteric artery (IMA) during sigmoidectomy for diverticular disease. Method:  Randomized and non-randomized clinical trials were identified using the following electronic databases: Medline, Embase, Cochrane Central Register of Controlled Trials, CINAHL, BioMed Central, Science Citation Index, Greynet, SIGLE, National Technological Information Service, British Library Integrated catalogue. The analyzed end points were the anastomotic leakage rate, overall morbidity and 30-day postoperative mortality. Results:  Four studies were included including 400 patients. The anastomotic leakage rate was 7.8% in the preservation group and 11.2% in the ligation group. There was no statistically ignificant difference between the groups (OR 0.95 [95% CI 0.09 - 9.90]; p = 0.96). Overall morbidity and 30-day postoperative mortality were not compared since these data were reported in only study. Conclusion:  The meta-analysis did not show any advantage for preservation of the IMA during sigmoid colectomy for diverticular disease in terms of anastomotic leakage.