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International Journal of Colorectal Disease

, Volume 27, Issue 11, pp 1521–1529 | Cite as

Different approaches for complete mobilization of the splenic flexure during laparoscopic rectal cancer resection

  • Volker Benseler
  • Matthias Hornung
  • Igors Iesalnieks
  • Philipp von Breitenbuch
  • Gabriel Glockzin
  • Hans J. Schlitt
  • Ayman Agha
Original Article

Abstract

Purpose

Laparoscopic resection of rectal cancer has already become the standard procedure in many hospitals. The splenic flexure mobilization (SFM) is an important preparational step. Several methods are used for laparoscopic SFM; however, studies comparing different approaches are lacking. In the present study, three different approaches for SFM have been compared to each other.

Methods

Between January 1998 and December 2010, 415 patients with rectal adenocarcinoma underwent laparoscopic rectal resection at one center. Of these, 303 patients received complete splenic flexure mobilization. The SFM was performed using either a medial (SFM-M; n = 41), lateral (SFM-L; n = 214), or anterior (SFM-A; n = 48) approach.

Results

There was a significantly higher rate of intraoperative complications in the SFM-L group as compared to the SFM-M or the SFM-A group (p = 0.038). Postoperative surgical complications occurred in 5 (10.6 %) patients of the SFM-A group compared to 38 patients (17.7 %) in the SFM-L group (p = 0.002) and 5 (12.1 %) patients in the SFM-M group (p = 0.037). SFM-L was also associated with a higher frequency of overall postoperative morbidity which was mainly due to wound infection rates (p = 0.001).

Conclusions

The anterior approach for SFM in laparoscopic surgery seems to be associated with lower frequency of intra- and postoperative morbidity.

Keywords

Laparoscopy Laparoscopic surgery Splenic flexure mobilization Rectal resection Rectal cancer 

Abbreviations

CSFM

Complete splenic flexure mobilization

IMV

Inferior mesenteric vein

PSFM

Partial splenic flexure mobilization

SFM

Splenic flexure mobilization

SFM-A

Splenic flexure mobilization anterior approach

SFM-L

Splenic flexure mobilization lateral approach

SFM-M

Splenic flexure mobilization medial approach

Notes

Disclosure

Drs. Agha, Hornung, Iesalnieks, von Breitenbuch, Glockzin, Schlitt, and Benseler have no conflicts of interest or financial ties to disclose.

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Copyright information

© Springer-Verlag 2012

Authors and Affiliations

  • Volker Benseler
    • 1
  • Matthias Hornung
    • 1
  • Igors Iesalnieks
    • 1
  • Philipp von Breitenbuch
    • 1
  • Gabriel Glockzin
    • 1
  • Hans J. Schlitt
    • 1
  • Ayman Agha
    • 1
  1. 1.Department of SurgeryUniversity Medical Center RegensburgRegensburgGermany

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