Master Program Colorectal Pathway: Laparoscopic Splenic Flexure Release (Tips and Tricks)
Splenic flexure release (SFR) is a fundamental skill to master when performing laparoscopic colorectal surgery. Some controversy exists regarding the need to perform SFR in all patients undergoing left-sided colorectal resections. This maneuver is not infrequently required and, when properly conducted, can provide significant benefits when considering restoration of bowel continuity. Gastrointestinal anastomoses carry significant morbidity associated with leaks when they occur. SFR can minimize anastomotic complications by optimizing tension-free anastomoses and adequate blood supply. Preoperative workup is usually based on patients’ baseline diagnosis. It is important to recognize potential variations in blood supply at the splenic flexure and the potential for bowel ischemia if inadvertent ligation of critical vessels is carried out or required. Release of the splenic flexure should be considered in the beginning of the procedure. There are three main approaches to SFR: the supramesocolic, inframesocolic, and lateral to medial approach. Surgeons performing laparoscopic colectomy should become familiar with all three techniques, and judgment is required when deciding which approach should be preferentially based in a given case. In addition to bowel ischemia, potential complications of SFR include bowel and organ injury to the spleen, pancreas, kidney, and splenic vessels. Thorough knowledge of the anatomy, understanding of each surgical approach to SFR, and meticulous surgical technique are the best tools to avoid injuries.
KeywordsSplenic flexure Left-side colectomy Tension-free anastomosis Blood supply Early release Supramesocolic Inframesocolic Lateral to medial Laparoscopic surgery Colorectal surgery
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