Splenic flexure mobilization is an essential role in laparoscopic low anterior resection!

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.

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Should Splenic Flexure be Routinely Mobilized During Laparoscopic Low Anterior Resection for Rectal Cancer?

Surgical Laparoscopy Endoscopy & Percutaneous Techniques ◽

10.1097/sle.0b013e3182937c67 ◽

2014 ◽

Vol 24 (3) ◽

pp. 283-284

Author(s):

Chao Tian ◽

Hui Li ◽

Wen-Jian Meng

Keyword(s):

Rectal Cancer ◽

Anterior Resection ◽

Splenic Flexure ◽

Low Anterior Resection ◽

Laparoscopic Low Anterior Resection

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Splenic flexure mobilization in low anterior resection

International Surgery Journal ◽

10.18203/2349-2902.isj20191087 ◽

2019 ◽

Vol 6 (4) ◽

pp. 1040

Author(s):

Ahmed Maher Megreya ◽

Ahmed S. Elgammal ◽

Mahmoud A. Shahin

Keyword(s):

Rectal Cancer ◽

Blood Loss ◽

Anterior Resection ◽

Splenic Flexure ◽

Low Anterior Resection ◽

Lateral Approach ◽

P Value ◽

Splenic Flexure Mobilization ◽

Operative Blood Loss ◽

Medial Approach

Background: The use of splenic ﬂexure mobilization (SFM) for rectal cancer surgery is still controversial. SFM includes division of the splenocolic, phrenocolic, gastrocolic and pancreaticomesocolic ligaments, which is time-consuming. The aim of present prospective study of low anterior resection in case of cancer rectum was to compare splenic ﬂexure mobilization (SFM) carried out by an extended medial approach with that by a lateral approach.Methods: A prospective study was carried out in General Surgery Department, Menoufia University, Egypt between October 2017 and December 2018. Patients were allocated randomly into two groups in which first group (group A) allocated to medial mobilization of splenic flexure and the second group was allocated into lateral approach of splenic flexure. The extended medial involved continuing the medial to lateral approach upwards to enter the lesser sac over the pancreas, thus permitting detachment of the splenic ﬂexure. However, lateral approach involves dissection of retroperitoneal fascia.Results: Thirty patients, including 20 undergoing a lateral SFM and 10 an extended medial SFM, were evaluated. Mean number of lymph nodes in lateral and medial approach are (17.7±5.6, 24.3±6 respectively) with significant (P-value=0.04). Interestingly, Intra-operative blood loss in lateral approach is more than medial approach (175±25.3, 160.1±30 respectively) with significant (p-value=0.02). The interval to oral intake (3±0.3 days extended medial, 4.1±0.7 lateral, P=0.14).Conclusions: An extended medial approach for SFM during low anterior resection of rectal cancer appears to be an improvement over the previously used lateral approach because it may provide a shorter operation time and higher number of harvested lymph nodes with less intra-operative blood loss.

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Laparoscopic splenic flexure mobilization during low anterior Resection for rectal cancer: a high-level component of surgeon's armamentarium

Colorectal Disease ◽

10.1111/codi.12297 ◽

2013 ◽

pp. n/a-n/a

Author(s):

Wen-Jian Meng ◽

Zi-Qiang Wang ◽

Zong-Guang Zhou

Keyword(s):

Rectal Cancer ◽

Anterior Resection ◽

Splenic Flexure ◽

Low Anterior Resection ◽

Splenic Flexure Mobilization ◽

High Level

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How Much Colonic Redundancy Could Be Obtained by Splenic Flexure Mobilization in Laparoscopic Anterior or Low Anterior Resection?

International Journal of Medical Sciences ◽

10.7150/ijms.8874 ◽

2014 ◽

Vol 11 (9) ◽

pp. 857-862 ◽

Cited By ~ 14

Author(s):

Bong-Hyeon Kye ◽

Hyung-Jin Kim ◽

Hyun-Sil Kim ◽

Jun-Gi Kim ◽

Hyeon-Min Cho

Keyword(s):

Anterior Resection ◽

Splenic Flexure ◽

Low Anterior Resection ◽

Splenic Flexure Mobilization

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Inter-ischial spine distance is a simple index of narrow pelvis that may predict difficulty during laparoscopic low anterior resection: a retrospective study

10.21203/rs.3.rs-607219/v1 ◽

2021 ◽

Author(s):

Nobuki Ichikawa ◽

Shigenori Homma ◽

Tadashi Yoshida ◽

Ken Imaizumi ◽

Yoichi Miyaoka ◽

...

Keyword(s):

Computed Tomography ◽

Rectal Cancer ◽

Blood Loss ◽

Anterior Resection ◽

Low Anterior Resection ◽

Operative Time ◽

Ischial Spine ◽

Laparoscopic Low Anterior Resection ◽

The Mean ◽

Narrow Pelvis

Abstract Background A narrow pelvis makes laparoscopic rectal resection difficult. This study aimed to evaluate whether a simple measurement on computed tomography can predict procedural difficulty. Methods A total of 62 patients with low rectal cancer underwent conventional laparoscopic low anterior resection. The inter-ischial spine (IS) distance (i.e., distance between the ischial spines) was measured on an axial computed tomography slice. Operative time, blood loss, and time from insertion of linear staplers to completion of clamping on the distal end of the rectum (clamp time) were compared. Results Overall, 42 men and 20 women with low rectal cancer were assessed. The mean tumor size was 34.5 mm. Total or tumor-specific mesorectal excisions were performed in all cases; high ligation and resection of the inferior mesenteric arteries were carried out in 92% of patients. The mean operative time, and blood loss were 206 min, and 15 mL respectively. Four patients (6.5%) experienced postoperative complications, including two anastomotic leaks (3.2%). The mean IS distance was 93.3 mm. With simple linear regression, shorter IS distance correlated with longer operative time (R2 = 0.08, P = 0.030) and clamp time (R2 = 0.07, P = 0.046). Using an receiver operating characteristic curve, a narrow pelvis was defined as IS distance < 94.7 mm. Multivariate regression analysis revealed that IS distance < 94.7 mm (odds ratio, 3.51; P = 0.04) was independently associated with a longer clamp time. Conclusions The IS distance is a simple and useful measurement for predicting the difficulty of laparoscopic low anterior resection.

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