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Variations in Peritoneal Lines of Attachment of the Sigmoid Colon in Adult Females

Alexandra L. Martin, Susan Read, Nadim Bou Zgheib, Jing-Yi Chern, Hye Sook Chon, Mian M. Shahzad, Robert M. Wenham, Mitchel S. Hoffman
Published: 5 December 2022

Abstract:Objective: Left adnexectomy and/or pelvic lymphadenectomy often require mobilization of the sigmoid colon to gain adequate exposure, which involves division of peritoneal attachments of the sigmoid colon. Variations in native sigmoid attachments and techniques needed to achieve adequate mobilization have not been well-described. Materials and Methods: This was a prospective cohort study of patients undergoing laparotomy, laparoscopy, or robotic surgery by a gynecologic oncologist. Exclusions were patients who had pelvic surgery (other than tubal ligation), pelvic radiation therapy, concurrent pelvic inflammatory processes, or extensive pelvic peritoneal disease (e.g., ovarian cancer, severe endometriosis). Detailed patient and clinical data were collected, along with anatomical findings in the sigmoid colon, such as diverticula; length; and sigmoid colon attachments relative to the infundibulopelvic ligament (IPL), broad ligament, and posterior cul-de-sac. Results: Of the 92 patients in the study, 75 had peritoneal attachments of the sigmoid colon or its mesentery. The most-common attachment location was lateral to the IPL only (n = 27; 36%), followed by lateral to the IPL and to the IPL (n = 15; 20%). The most-common type of attachment was congenital (n = 60; 45.5%), followed by adhesive (n = 58; 45%). Congenital attachment lateral to the IPL was the most-common at 24% of all documented attachments. Conclusions: Peritoneal attachments of the sigmoid colon are a common finding of natural anatomy and may be complex and/or multifocal, even in patients without risk factors. Knowledge of the peritoneal lines of attachment is important for having adequate exposure when performing left adnexectomy and/or pelvic lymphadenectomy. (J GYNECOL SURG 20XX:000)
Keywords: colon / sigmoid / peritoneum / lymph-node excision / minimally invasive surgical procedures

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