During a left hemicolectomy for adenocarcinoma at the splenic flexure, the surgeon ligates the inferior mesenteric artery flush with its origin from the aorta. What does this 'high tie' accomplish?
- A It removes the apical lymph node basin at the origin of the inferior mesenteric artery ✓
- B It preserves the marginal artery to improve anastomotic blood supply
- C It avoids injury to the hypogastric nerves more effectively than a low tie
- D It is performed solely to shorten operative time
Correct answer: A. It removes the apical lymph node basin at the origin of the inferior mesenteric artery
Explanation
High tie refers to division of the inferior mesenteric artery close to its aortic origin, which removes the apical nodes located at that origin and achieves a complete lymphadenectomy for cancers in its drainage territory. B low tie preserves the left colic artery origin and sacrifices fewer nodes. High tie may actually compromise collateral flow to the distal colon and increases theoretical autonomic nerve risk, so options B and C describe advantages of the opposite approach.
Reference: Bailey and Love's Short Practice of Surgery, 27th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.