Routine splenic flexure mobilization may increase compliance with pathological quality metrics in patients undergoing low anterior resection

2018 ◽  
Vol 21 (1) ◽  
pp. 23-29 ◽  
Author(s):  
T. J. Mouw ◽  
C. King ◽  
J. H. Ashcraft ◽  
J. D. Valentino ◽  
P. J. DiPasco ◽  
...  
Keyword(s):  
Anterior Resection ◽  
Splenic Flexure ◽  
Low Anterior Resection ◽  
Quality Metrics ◽  
Splenic Flexure Mobilization

scholarly journals Splenic flexure mobilization in low anterior resection

2019 ◽  
Vol 6 (4) ◽  
pp. 1040
Author(s):  
Ahmed Maher Megreya ◽  
Ahmed S. Elgammal ◽  
Mahmoud A. Shahin
Keyword(s):  
Rectal Cancer ◽  
Blood Loss ◽  
Anterior Resection ◽  
Splenic Flexure ◽  
Low Anterior Resection ◽  
Lateral Approach ◽  
P Value ◽  
Splenic Flexure Mobilization ◽  
Operative Blood Loss ◽  
Medial Approach

Background: The use of splenic flexure mobilization (SFM) for rectal cancer surgery is still controversial. SFM includes division of the splenocolic, phrenocolic, gastrocolic and pancreaticomesocolic ligaments, which is time-consuming. The aim of present prospective study of low anterior resection in case of cancer rectum was to compare splenic flexure mobilization (SFM) carried out by an extended medial approach with that by a lateral approach.Methods: A prospective study was carried out in General Surgery Department, Menoufia University, Egypt between October 2017 and December 2018. Patients were allocated randomly into two groups in which first group (group A) allocated to medial mobilization of splenic flexure and the second group was allocated into lateral approach of splenic flexure. The extended medial involved continuing the medial to lateral approach upwards to enter the lesser sac over the pancreas, thus permitting detachment of the splenic flexure. However, lateral approach involves dissection of retroperitoneal fascia.Results: Thirty patients, including 20 undergoing a lateral SFM and 10 an extended medial SFM, were evaluated. Mean number of lymph nodes in lateral and medial approach are (17.7±5.6, 24.3±6 respectively) with significant (P-value=0.04). Interestingly, Intra-operative blood loss in lateral approach is more than medial approach (175±25.3, 160.1±30 respectively) with significant (p-value=0.02). The interval to oral intake (3±0.3 days extended medial, 4.1±0.7 lateral, P=0.14).Conclusions: An extended medial approach for SFM during low anterior resection of rectal cancer appears to be an improvement over the previously used lateral approach because it may provide a shorter operation time and higher number of harvested lymph nodes with less intra-operative blood loss.

scholarly journals Splenic flexure mobilization is an essential role in laparoscopic low anterior resection!

2019 ◽  
Vol 6 (12) ◽  
pp. 4210
Author(s):  
Mohamed Hamed Elmeligi ◽  
Mohamed Sabry Amar ◽  
Mohammed Nazeeh Shaker Nassar
Keyword(s):  
Anterior Resection ◽  
Splenic Flexure ◽  
Conversion Rate ◽  
Low Anterior Resection ◽  
Operative Time ◽  
Splenic Flexure Mobilization ◽  
Partial Group ◽  
Laparoscopic Low Anterior Resection ◽  
Group A ◽  
Group B

Background: Routine mobilization of splenic flexure whether partial or complete became an essential step in laparoscopic low anterior resections in order to perform an oncologic re­section and to achieve a safe, tension-free anastomosis.Methods: 60 patients with rectal cancer were operated by laparoscopic low anterior resection with high ligation of inferior mesenteric artery in general surgery department, Menoufia university hospital between February 2016 and January 2019. All patients were divided randomly into 2 equal groups based on the techniques used in splenic flexure mobilization whether partial (group A) or complete (group B).Results: The majority of our patients were male 56.6% and 60% in both groups respectively with mean age (54.6±8.8) years in group A and mean age (58.5±9.2) years in group B. The operative time was highly significant lower in group A (269±17.6 minutes) than group B (304±22.4 minutes) while the conversion rate was significantly higher in group B (26.6%) than group A (6.6%). Regarding the postoperative data there was only significantly higher leak from the anastomosis in group A (20%) than group B (3.3%).Conclusions: Complete splenic flexure offer better oncological outcome and low incidence of anastomotic leak but with higher conversion rate, prolonged operative time, more blood loss and more 30 day mortality rate. So it needs more time to gain more experience to overcome these disadvantages.

scholarly journals A Decalogue to Avoid Routine Ileostomy in Selected Patients With Border Line Risk to Develop Anastomotic Leakage After Minimally Invasive Low-Anterior Resection: A Pilot Study

2019 ◽  
Vol 27 (1) ◽  
pp. 44-53
Author(s):  
Salvador Morales-Conde ◽  
Isaias Alarcón ◽  
Tao Yang ◽  
Eugenio Licardie ◽  
Andrea Balla
Keyword(s):  
Anastomotic Leakage ◽  
Anterior Resection ◽  
Low Anterior Resection ◽  
Fluorescence Angiography ◽  
Splenic Flexure Mobilization ◽  
Horizontal Section ◽  
Border Line ◽  
Ghost Ileostomy ◽  
Protective Ileostomy ◽  
Methylene Blue Test

Purpose. Protective ileostomy (PI) during anterior resection (AR) for rectal cancer decreases the incidence of anastomotic leakage (AL) and its subsequent complications, but it may itself be the cause of morbidity. The aim is to report our protocol in the management of selected patients with borderline risk to develop AL after laparoscopic AR and ghost ileostomy (GI) creation. Methods. Patients who underwent AR were stratified based on the risk to develop AL. Steps to avoid PI were splenic flexure mobilization, reduced pelvic bleeding, to employ different stapler charge if neoadjuvant chemo-radiotherapy is performed, to perform a horizontal section of the rectum, to evaluate the anastomotic vascularization with a fluorescence angiography, to perform a side-to-end anastomosis, intraoperative methylene blue test, pelvic and transanal drainage tubes placement, and the GI creation. After surgery, inflammatory blood markers were monitored to detect potential leakages. Results. Twelve patients were included. In one case, the specimen proximal section was changed after fluorescence angiography. There were no conversions in this group of patients. One postoperative AL occurred and was treated with radiological drainage placement, not being necessary to convert the GI. PI was avoided in 100% of cases. Conclusions. Patients’ characteristics cannot be changed, but several steps were used to avoid routine PI creation. The present protocol could be a valuable option to avoid PI in selected patients. Further studies with a wider sample size, and defined criteria to stratify the patients based on the risk to develop AL, are required.

What are 30-day postoperative outcomes following splenic flexure mobilization during anterior resection?

2013 ◽  
Vol 18 (3) ◽  
pp. 257-264 ◽  
Author(s):  
R. M. Carlson ◽  
P. L. Roberts ◽  
J. F. Hall ◽  
P. W. Marcello ◽  
D. J. Schoetz ◽  
...  
Keyword(s):  
Anterior Resection ◽  
Splenic Flexure ◽  
Postoperative Outcomes ◽  
Splenic Flexure Mobilization
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