Method for laparoscopic medial-lateral mobilization of the splenic flexure of the colon during anterior resection of the rectum

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BACKGROUND

Splenic flexure mobilization (SFM) is an effective way to increase the length of the colon to the small pelvis when performing sphincter-preserving operations on the rectum, which allows you to create a colorectal anastomosis without tension. Features of the topographic anatomy of the splenic flexure make SFM a complex procedure in terms of safety, especially when performing colorectal operations using laparoscopic access.

OBJECTIVE

Safety assessment of the proposed method of laparoscopic medial-lateral SFM for anterior rectal resection.

MATERIAL AND METHODS

Known laparoscopic method of medial-lateral SFM of the colon according to the method of Armando Melani with the formation of «Melani window» in the mesentery of the transverse colon to enter the lesser sac and subsequent medial-lateral mobilization and separation from the pancreas. To ensure the safety of dissection of the mesentery of the transverse colon during the formation of «Melani window» to reduce the risk of damage to blood vessels and the pancreas, we proposed a method by which the entrance to the lesser sac is performed in the avascular zone of the mesentery after transillumination with a special illuminator, which makes it possible to visualize the vascular architectonics. In a cohort of thirty patients, the proposed method of laparoscopic medial-lateral SFM for anterior resection of the rectum was used in 7 patients. In the control group, 23 patients underwent medial-lateral SFM as standard.

RESULTS

Damage to the spleen occurred in 1 case in a patient of the control group, which was 0.23%. The difference between groups in the incidence of this complication was not statistically significant (p=0.27). There were no cases of damage to the vessels of the mesentery of the SF in the comparison groups.

CONCLUSION

The proposed method of laparoscopic medial-lateral SFM is safe and easy to perform.

Keywords:

splenic flexure mobilization

left colonic flexure mobilization

Authors:

Polovinkin V.V.

Research Institute — Ochapovsky Regional Clinical Hospital No. 1

ORCID: 0000-0003-3649-1027

Pryn’ P.S.

Research Institute — Ochapovsky Regional Clinical Hospital No. 1

ORCID: 0000-0002-5481-390X

Received:

05.03.2023

Accepted:

10.05.2023

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