What are 30-day postoperative outcomes following splenic flexure mobilization during anterior resection?

Abstract

Operating room times are longer and superficial surgical site infections are more common when the splenic flexure is mobilized. The absolute indications for splenic flexure mobilization should be addressed in further research.

Routine splenic flexure mobilization may increase compliance with pathological quality metrics in patients undergoing low anterior resection

“…It is well understood that additional surgical mobilization can predispose patients to morbidity. SFM has been associated with increased operative times, increased rates of superficial surgical site infection and splenic injury . Given these facts, the need for SFM in distal colon and rectal surgery has become a highly debated topic, with some authors advocating against its routine use .…”

Neoadjuvant concurrent chemoradiotherapy followed by transanal total mesorectal excision assisted by single-port laparoscopic surgery for low-lying rectal adenocarcinoma: a single center study

“…[38,39] In effect, mobilization of the splenic exure was mainly performed in patients with a short left mesentery. [40] However, mobilization of the splenic exure was not free from intra-operative complications, like the spleen injury, and it increased the complexity of an already demanding operation, such as rectal resection. [41][42][43] In addition, limitations to TaTME included the inability to completely visualize the intracoelomic cavity, transect the inferior mesenteric artery in an oncologic high ligation fashion, and mobilization of the splenic exure.…”

Complicated Diverticular Disease

“…The role of SFM in surgery for complicated diverticulitis is colon elongation for a tension-free anastomosis. Some studies indicate length gained with SFM, ligation of IMA, and ligation of inferior mesenteric vein (IMV) at 28 to 30 cm, 60,61 while others indicate that only 3 to 6 cm is gained when adding SFM to high-IMA ligation and complete mobilization of the descending colon to the splenic flexure. 61,62 Authors suggest more length was gained by performing high ligation of the IMA, ligation of the IMV at inferior border of the pancreas, and mobilizing the entire descending colon without SFM.…”

“…Some studies indicate length gained with SFM, ligation of IMA, and ligation of inferior mesenteric vein (IMV) at 28 to 30 cm, 60,61 while others indicate that only 3 to 6 cm is gained when adding SFM to high-IMA ligation and complete mobilization of the descending colon to the splenic flexure. 61,62 Authors suggest more length was gained by performing high ligation of the IMA, ligation of the IMV at inferior border of the pancreas, and mobilizing the entire descending colon without SFM. Further, SFM is associated with 10 to 20% increased operative time, 60,61,63 increased use during laparoscopy, and when diverticulitis involves the descending colon.…”

“…Further, SFM is associated with 10 to 20% increased operative time, 60,61,63 increased use during laparoscopy, and when diverticulitis involves the descending colon. 63 Complications attributed to SFM are contradictory in the literature, with some suggesting increased rates of surgical site infection (SSI) 61 and others reporting no difference. 63 Bleeding is a very uncommon complication of SFM.…”