Splenic flexure mobilization is an essential role in laparoscopic low anterior resection!
DOI:
https://doi.org/10.18203/2349-2902.isj20195377Keywords:
Splenic flexure mobilization, Laparoscopic surgery, Low anterior resectionAbstract
Background: Routine mobilization of splenic flexure whether partial or complete became an essential step in laparoscopic low anterior resections in order to perform an oncologic resection and to achieve a safe, tension-free anastomosis.
Methods: 60 patients with rectal cancer were operated by laparoscopic low anterior resection with high ligation of inferior mesenteric artery in general surgery department, Menoufia university hospital between February 2016 and January 2019. All patients were divided randomly into 2 equal groups based on the techniques used in splenic flexure mobilization whether partial (group A) or complete (group B).
Results: The majority of our patients were male 56.6% and 60% in both groups respectively with mean age (54.6±8.8) years in group A and mean age (58.5±9.2) years in group B. The operative time was highly significant lower in group A (269±17.6 minutes) than group B (304±22.4 minutes) while the conversion rate was significantly higher in group B (26.6%) than group A (6.6%). Regarding the postoperative data there was only significantly higher leak from the anastomosis in group A (20%) than group B (3.3%).
Conclusions: Complete splenic flexure offer better oncological outcome and low incidence of anastomotic leak but with higher conversion rate, prolonged operative time, more blood loss and more 30 day mortality rate. So it needs more time to gain more experience to overcome these disadvantages.
References
Thum-umnuaysuk S, Boonyapibal A, Geng YY, Pattana-arun J. Lengthening of the colon for low rectal anastomosis in a cadaveric study: how much can we gain? Techniques Coloproctol. 2013;17:377–81
Park JS, Kang SB, Kim DW, Lee KH, Kim YH. Laparoscopic versus open resection without splenic flexure mobilization for the treatment of rectum and sigmoid cancer: a study from a single institution that selectively used splenic flexure mobilization. Surg Laparosc Endosc Percutan Tech. 2009;19(1):62-8.
Gezen C, Altuntas YE, Kement M, Vural S, Civil O, Okkabaz N, et al. Complete Versus Partial Mobilization of Splenic Flexure during Laparoscopic Low Anterior Resection for Rectal Tumors: A comparative study. J Laparoendoscopic Advanced Surgl Techn. 2014;24(3):283-4.
Kim J, Choi DJ, Kim SH. Laparoscopic rectal resection without splenic flexure mobilization: a prospective study assessing anastomotic safety. Hepatogastroenterol. 2009;56:1354-8.
Alici A, Kement M, Gezen C, Akin T, Vural S, Okkabaz N, et al. Apical lymph nodes at the root of the inferior mesenteric artery in distal colorectal cancer: An analysis of the risk of tumor involvement and the impact of high ligation on anastomotic integrity. Tech Co- loproctol. 2010;14:1-8.
Feliciotti F, Guerrieri M, Paganini AM, De Sanctis A, Campagnacci R, Perretta S, et al. Long-term results of laparoscopic versus open resections for rectal cancer for 124 unselected patients. Surg Endosc. 2003;17:1530-5.
Dulucq JL, Wintringer P, Stabilini C, Mahajna A. Laparoscopic rectal resection with anal sphincter preservation for rectal cancer: Long-term outcome. Surg Endosc. 2005;19:1468-74.
Tsang WW, Chung CC, Kwok SY, Li MKW. Laparoscopic sphincter preserving total mesorectal excision with colonic J- pouch reconstruction: Five-year results. Ann Surg. 2006;243:353-8.
Leung KL, Kwok SP, Lam SC, Lee JF, Yiu RY, Ng SS, et al. Laparoscopic resection of rectosigmoid carcinoma: Prospective randomised trial. Lancet. 2004;363:1187-92.
Brennan DJ, Moynagh M, Brannigan AE, Gleeson F, Rowland M, O'Connell PR. Routine mobilization of the splenic flexure is not necessary during anterior resection for rectal cancer. Dis Colon Rect. 2007;50:302-7.
Katory M, Tang CL, Koh WL, Fook-Chong SM, Loi TT, Ooi BS, et al. A 6-year review of surgical morbidity and oncologic outcome after high anterior resection for colorectal malignancy without splenic flexure mobilisation. Colorectal Dis. 2008;10:165-9.
Park JS, Kang SB, Kim DW, Lee KH, Kim YH. Laparoscopic versus open resection without splenic flexure mobilization for the treat¬ment of rectum and sigmoid cancer: A study from a single institution that selectively used splenic flexure mobilization. Surg Laparosc Endosc Percutan Tech. 2009;19:62-8.
Frame RJ, Wahed S, Mohiuddin MK, Katory M. Right lateral position for laparoscopic splenic flexure mobilization. Colorectal Dis. 2011;13:178-80.
Wang JK, Holubar SD, Wolff BG, Follestad B, O'Byrne MM, Qin R. Risk factors for splenic injury during colectomy: A matched case-control study. World J Surg. 2011;35:1123-9.
