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.