Different approaches for complete mobilization of the splenic flexure during laparoscopic rectal cancer resection
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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.
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.
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).
The anterior approach for SFM in laparoscopic surgery seems to be associated with lower frequency of intra- and postoperative morbidity.
KeywordsLaparoscopy Laparoscopic surgery Splenic flexure mobilization Rectal resection Rectal cancer
Complete splenic flexure mobilization
Inferior mesenteric vein
Partial splenic flexure mobilization
Splenic flexure mobilization
Splenic flexure mobilization anterior approach
Splenic flexure mobilization lateral approach
Splenic flexure mobilization medial approach
Drs. Agha, Hornung, Iesalnieks, von Breitenbuch, Glockzin, Schlitt, and Benseler have no conflicts of interest or financial ties to disclose.
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