Publication:

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

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.