During laparoscopic left hemicolectomy for sigmoid colon cancer, the surgeon identifies the inferior mesenteric artery (IMA). To perform a high ligation of IMA while preserving autonomic function, the dissection should be medial to:
- A Superior hypogastric plexus at the aortic bifurcation ✓
- B Hypogastric nerve trunks at the sacral promontory
- C Pelvic splanchnic nerves (S2-S4)
- D Inferior hypogastric plexus at the lateral pelvic sidewall
Explanation
During IMA ligation for left colonic cancer, the superior hypogastric plexus (presacral nerves) lies posterior to the IMA origin, running in the adventitia of the aorta and across the aortic bifurcation. Dissection should remain medial (anterior) to this plexus during IMA ligation to preserve sympathetic fibers responsible for bladder neck function and ejaculation in males. Injury to the superior hypogastric plexus causes retrograde ejaculation and bladder dysfunction. The hypogastric nerves and inferior hypogastric plexus are at risk during deeper rectal dissection. Pelvic splanchnic nerves (parasympathetic) run laterally in the pelvis and control erection.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
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Written and medically reviewed by the StethoPrep medical team.