We dissected the retroperitoneum laterally to the level of the descending colon and then to the lower border of the pancreas superiorly. We thought it best to perform this procedure after the high ligation since the avascular plane can be found more easily. After performing high ligation of the inferior mesenteric artery (IMA), we separated the retroperitoneum from the mesocolon of the descending and transverse colon from the medial to the lateral side. 1) Mobilization of the mesocolonīefore dissecting the colon, we placed a surgical clip on a sigmoid-descending (SD) colon junction to mark the spot “A” (Figure 1). Surgical procedureĪll the surgeries were performed by 3 colorectal surgeons. After receiving institutional review board approval, we studied retrospectively these 203 patients who had undergone laparoscopic AR or LAR with SFM for the treatment of sigmoid colon or rectal cancer. Of the 110 patients with rectal cancer, 70 underwent neoadjuvant chemoradiotherapy. 110 of these patients had rectal cancer, 32 had rectosigmoid junction colon cancer, and 61 had sigmoid colon cancer. Vincent's Hospital, The Catholic University of Korea, from July 2009 to November 2012 were available. The data of 203 patients concerning colon elongation by SFM in laparoscopic AR or LAR at the Department of Surgery, St. In this study, we aimed to determine the possible degree of obtainable redundancy of the colon by SFM in laparoscopic AR or LAR and evaluate the safety of SFM. However, no study has measured colon elongation by SFM during actual surgery, especially in laparoscopic surgery. Two cadaveric studies recently demonstrated the degree to which the use of SFM could lengthen the colon. Considering this controversy, we believe it necessary to determine how much colonic redundancy can be obtained by SFM to identify whether colorectal surgeons should do it or not.
However, many surgeons still believe that SFM is necessary to ensure a tension-free and well-vascularized anastomosis. According to a mail-in survey completed by 35 experienced laparoscopic colorectal surgeons, SFM is one of the hardest procedures to perform. SFM is considered more difficult in laparoscopic colorectal resection than in open surgery and is usually done only in selective cases. SFM was routinely performed in the past however, some surgeons now use it only when necessary because it is a difficult step within both conventional and laparoscopic procedures and may require more time, patient repositioning, a longer incision, or additional port insertion. The use of splenic flexure mobilization (SFM) during anterior resection (AR) or low anterior resection (LAR) can facilitate tension-free anastomosis with an adequate cancer-free margin by straightening a splenic flexure colon. Colorectal anastomosis failure contributes to both the morbidity and mortality of patients undergoing rectal surgery and the increased risk of local cancer recurrence. Securing adequate mobilization and preserving the blood supply to the organ ends are required to ensure safe gastrointestinal anastomosis. Keywords: laparoscopic anterior resection, laparoscopic low anterior resection, splenic flexure mobilization Introduction Based on the result of this study, one can gain about 27.81 cm redundancy of the colon by SFM. There was no intraoperative complication during SFM.Ĭonclusions: SFM during laparoscopic AR or LAR is a safe and feasible option. It took about 9.82% of the total operation time to perform SFM. The redundancy of the colon by SFM with high ligation of the inferior mesenteric vein (IMV) (29.54 ± 7.17 cm from the sacral promontory) was greater than that with low ligation of the IMV (24.94 ± 6.07 cm from the sacral promontory, P < 0.0001).
Results: The obtained redundancy of the colon by SFM was 27.81 ± 7.29 cm from the sacral promontory. Methods: Retrospective review of medical record for a total of 203 patients who underwent SFM during laparoscopic AR or LAR for the treatment of sigmoid colon or rectal cancer was performed. This retrospective study was performed to determine the amount of colonic redundancy that can be expected by SFM.
File import instruction Abstractīackground and Objectives: Splenic flexure mobilization (SFM) is performed to ensure a tension free anastomosis with an adequate resection margin in laparoscopic anterior resection (AR) or low anterior resection (LAR).
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