In case of an insufficient vascular supply through the middle colonic artery, the vascular supply can be warranted through the left colonic artery, if a sufficient Riolan's arcade exists.
This approach ensures an isoperistaltic reconstruction (standard procedure). Care has to be taken not to injure the left colic vessels. Therefore preparation has to be done carefully and closely to the wall of the colon, and transection of the descending colon is always done without extensive dissection of the colon using a linear stapler device. The right and middle colonic vessels are dissected close to their origin. A prophylactic appendectomy after total mobilization of the colon is recommended.
An anisoperistaltic colon interposition supplied by the left colonic artery can be performed, if the Riolan's anastomosis is either not present or is insufficient due to previous surgical procedures.
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