Splenic flexure and left hemicolectomy

2017 ◽  
pp. 87-99
Author(s):  
Kathryn Thomas ◽  
Charles Maxwell-Armstrong ◽  
Austin Acheson
Keyword(s):  
Splenic Flexure ◽  
Left Hemicolectomy

scholarly journals Laparoscopic left hemicolectomy with regional lymph node navigation and intracorporeal anastomosis for splenic flexure colon cancer

2020 ◽  
Vol 9 (4) ◽  
pp. 170-174
Author(s):  
Yoshiro Itatani ◽  
Kenji Kawada ◽  
Koya Hida ◽  
Yasunori Deguchi ◽  
Nobu Oshima ◽  
...  
Keyword(s):  
Colon Cancer ◽  
Lymph Node ◽  
Splenic Flexure ◽  
Regional Lymph Node ◽  
Intracorporeal Anastomosis ◽  
Left Hemicolectomy

scholarly journals Long splenic flexure carcinoma requiring laparoscopic extended left hemicolectomy with CME and transverse-rectal anastomosis: technique for a modified partial Deloyers in 5 steps to achieve enough reach and preserving middle colic vessels

2021 ◽  
Author(s):  
Salomone Di Saverio ◽  
Kostantinos Stasinos ◽  
Weronyka Stupalkowska ◽  
Umberto Bracale ◽  
Pierpaolo Sileri ◽  
...  
Keyword(s):  
Splenic Flexure ◽  
Primary Anastomosis ◽  
Colorectal Anastomosis ◽  
Ascending Colon ◽  
Right Colon ◽  
Left Hemicolectomy ◽  
Tension Free ◽  
Descending Colon ◽  
Deloyers Procedure ◽  
The Right

Abstract Introduction This How-I-Do-It article presents a modified Deloyers procedure by mean of the case of a 67-year-old female with adenocarcinoma extending for a long segment and involving the splenic flexure and proximal descending colon who underwent a laparoscopic left extended hemicolectomy (LELC) with derotation of the right colon and primary colorectal anastomosis. Background While laparoscopic extended right colectomy is a well-established procedure, LELC is rarely used (mainly for distal transverse or proximal descending colon carcinomas extending to the area of the splenic flexure). LELC presents several technical challenges which are demonstrated in this How-I-Do-It article. Technique and methods Firstly, the steps needed to mobilize the left colon and procure a safe approach to the splenic flexure are described, especially when a tumor is closely related to it. This is achieved by mobilization and resection of the descending colon, while maintaining a complete mesocolic excision to the level of the duodenojejunal ligament for the inferior mesenteric vein and flush to the aorta for the inferior mesenteric artery. Subsequently, we depict the adjuvant steps required to enable a primary anastomosis by trying to mobilize the transverse colon and release as much of the mesocolic attachments at the splenic flexure area. Finally, we present the rare instance when a laparoscopic derotation of the ascending colon is required to provide a tension-free anastomosis. The resection is completed by delivery of the fully derotated ascending colon and hepatic flexure through a suprapubic mini-Pfannenstiel incision. The primary colorectal anastomosis is subsequently fashioned in a tension-free way and provides for a quick postoperative recovery of the patient. Results This modified Deloyers procedure preserves the middle colic since the fully mobilized mesocolon allows for a tension-free anastomosis while maintaining better blood supply to the mobilized stump. Also, by eliminating the need for a mesenteric window and the transposition of the caecum, we allow the small bowel to rest over the anastomosis and the mobilized transverse colon and reduce the possibility of an internal herniation of the small bowel into the mesentery. Conclusions Laparoscopic derotation of the right colon and a partial, modified Deloyers procedure preserving the middle colic vessels are feasible techniques in experienced hands to provide primary anastomosis after LELC with improved functional outcome. Nevertheless, it is important to consider anatomical aspects of the left hemicolectomy along with oncological considerations, to provide both a safe oncological resection along with good postoperative bowel function.

Subtotal colectomy versus left hemicolectomy for the elective treatment of splenic flexure colonic neoplasia

2018 ◽  
Vol 216 (2) ◽  
pp. 251-254 ◽  
Author(s):  
Marc Beisani ◽  
Francesc Vallribera ◽  
Albert García ◽  
Laura Mora ◽  
Sebastiano Biondo ◽  
...  
Keyword(s):  
Splenic Flexure ◽  
Subtotal Colectomy ◽  
Left Hemicolectomy ◽  
Colonic Neoplasia ◽  
Elective Treatment

scholarly journals Splenic Flexure Cancer: Segmental Colonic Resection, Left Hemicolectomy, Extended Right Hemicolectomy or Total Colectomy? Short-Term and Long-Term Outcomes

2016 ◽  
Vol 6 (1) ◽  
pp. 1-9
Author(s):  
Bono D ◽  
Galati S ◽  
Potenza E ◽  
Loddo F ◽  
Bonaccors L ◽  
...  
Keyword(s):  
Postoperative Complications ◽  
Splenic Flexure ◽  
Total Colectomy ◽  
Surgical Techniques ◽  
Right Hemicolectomy ◽  
Colonic Resection ◽  
Short Term ◽  
Left Hemicolectomy ◽  
Splenic Flexure Cancer

Introduction: Splenic flexure tumors are quite rare, accounting for 2% to 8% of all colorectal cancers. The heterogeneity of the vascular support and lymphatic drainage of the splenic flexure make the surgical management complex and non-standardized. The aim of the study is to compare the four surgical techniques (extended right hemicolectomy, left hemicolectomy, segmental colonic resection, and total colectomy) in terms of short-term and long-term outcomes.Materials and Methods: Consecutive patients from two hospitals of Turin (the Martini hospital and the San Giovanni Bosco hospital) between September 1998 and March 2020 have surgical visit for splenic flexure cancer. The data reported in the database include preoperative, postoperative, histopathological characteristics, and survival results. Univariate and multivariate analysis are performed to evaluate the confounding factors influencing overall and disease-free survival.Results and Discussion: A total of 173 patients treated for splenic flexure tumors are included in the study. The four groups are similar on the baseline characteristics of the patients. Clavien Dindo ≥ 3 postoperative complications and 30-day mortality are comparable in the four groups (p=0.216 e p=0.213). Five-year overall survival and progression-free survival did not show significant differences between the four surgical techniques (p=1.08 e p=0.28). No statistically significant differences were found between the four groups for baseline patient characteristics, intraoperative outcomes, postoperative complications, and TNM staging.Conclusion: Segmental colonic resection, extended right hemicolectomy, left hemicolectomy and total colectomy show no significant difference in short-term and oncological outcomes in cancer of the splenic flexure. Further studies with a higher level of evidence are needed.

Laparoscopic radical left hemicolectomy: Use of a bursa omentalis approach to ease splenic flexure mobilization.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e15071-e15071
Author(s):  
Wei Wang ◽  
Wei Wang ◽  
Wenjun Xiong ◽  
Jin Wan
Keyword(s):  
Splenic Flexure ◽  
Operation Time ◽  
Lateral Approach ◽  
Splenic Flexure Mobilization ◽  
Left Hemicolectomy ◽  
Laparoscopic Operation ◽  
Bursa Omentalis ◽  
Significant Difference ◽  
Toldt’S Fascia ◽  
Radical Left

e15071 Background: Laparoscopic splenic flexure mobilization was technically difficult for left colon cancer. This study was aimed to compare the safety and feasibility of laparoscopic radical left hemicolectomy using a bursa omentalis approach (BOA) versus medial-to-lateral approach (MtLA). Methods: BOA was entering the bursa omentalis prior to separating left Toldt’s fascia. We retrospectively analyzed data of 32 cases undergoing laparoscopic radical left hemicolectomy using BOA, matching with using MtLA from January 2013 and October 2016. The matching factors consisted of gender, age, ASA score, BMI, and TNM stage. Data of intraoperative and postoperative characteristics were reviewed. Splenic flexure mobilization time was defined as laparoscopic operation time minus left Toldt’s fascia separating time. Results: There was no significant difference in average time of ambulation, time to first flatus, hospital stay between two groups. The operative time was also similar between two groups (134.2±27.6 min vs 139.4±23.5 min. P = 0.42), but there are significantly shorter splenic flexure mobilization time in BOA group (25.9±12.3 min vs 35.5±22.5 min. P = 0.03). No entry to posterior pancreatic space was recorded in BOA group and 9.4% (3/32) were wrongly entering to posterior pancreatic space when separating left Toldt’s fascia in MtLA group. However, there was no significant difference in intra- or postoperative complication between groups. Conclusions: Our initial results suggest BOA for laparoscopic radical left hemicoletomy may be safe and feasible approach especially for unexperienced surgeons. The main advantages of present approach contain easy to identify pancreas and avoiding wrongly entering posterior pancreatic space when expanding the left Told’s fascia.

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