The mobilised sigmoid colon is retracted anteriorly and laterally. The vascular pedicle is divided from the fascia covering aorta. In this connection, it is necessary to identify superior hypogastric plexus and leave it on the fascia. Upon division of the vascular pedicle up to the area where the a. mesenteric inferior (IMA) takes off the aorta, surgeons should be very careful with the left branch of sympathetic pre-aortic trunk, as the pedicle is closely adjoined to it over a length of 2-3 cm. After confirming that the left ureter is out of the operative field, a high ligation of IMA is performed at the area where it takes off the aorta. When there are no data on the lymphovenous invasion and the tumour is low-dimensional, it is possible to perform low ligation of the vessel just distal to the takeoff of the left colic artery. The v. mesenteric inferior is ligated separately according to the level of artery ligation. Next the mesentery of sigmoid is serially clamped, divided and ligated from the point of the pedicle ligation to the level at which the colon will ultimately be divided. This level is determined by holding the colon up to the abdominal wall to be certain the colostomy can be constructed without tension.
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