# Vascular Reconstruction With Autologous Venovenous Grafting After Complete Transection of the Superior Mesenteric Vein (SMV) During Right Hemicolectomy (RH) With Complete Mesocolic Excision (CME)

## TL;DR

This paper describes a rare but severe complication during a complex colon cancer surgery and its successful treatment using a patient's own vein graft.

## Contribution

The paper presents a case of complete SMV transection during RH/CME and its management with autologous venovenous grafting.

## Key findings

- Complete transection of the superior mesenteric vein occurred during RH/CME.
- The injury was successfully repaired using autologous venovenous grafting.
- Surgeons must be trained to manage such high-risk complications.

## Abstract

Right hemicolectomy (RH) with complete mesocolic excision (CME) for right-sided colon cancer has been recommended by experts as the optimal approach in terms of oncologic and survival outcomes. However, intraoperative adverse events, such as iatrogenic vascular injuries, are more commonly associated with CME as opposed to the conventional method. This report delineates a severe injury to the superior mesenteric vein (SMV) with complete transection of the vessel during RH/CME, which was definitively managed with autologous venovenous grafting. Awareness of the risks, familiarity with the anatomy, and adequate training are mandatory for colorectal surgeons in order to master a technique with a steep learning curve and be able to manage potentially disastrous complications.