Abstract
Background. Splenic flexure mobilization (SFM) is a difficult step within both conventional and laparoscopic procedures, often associated with intra- and postoperative morbidity. Additional difficulties occur because of the lack of generally accepted methods for performing SFM. Despite many reports, the routine SFM during low rectal resections remains controversial. Aim. This paper presents the strategy for SFM used in our clinic, as well as the surgical treatment outcomes in patients who underwent low rectal resections with or without SFM. Methods. Two retrospective analyzes of the surgical procedures were made. In the first case, the results of all LS operations with SFM (n=120) were analyzed. In the second case, a retrospective analysis of the LS rectal resections was carried out (low anterior resection (LAR) with the SFM (n=32), pull-through rectal resection with the SFM (n=20) and LAR without SFM (n=94)). Results. In the first analysis, patients were divided into 4 groups: LS-left colectomy, LS-low anterior rectal resection, LS-colproctectomy, and LSpull-through rectal resection. There was no significant difference between the groups in terms of intra- and postoperative complications. In the second analysis, the differences in the operation time, blood loss and hospital stay between low rectal resections were not statistically significant. Anastomotic leakage was detected in 2 patients in the LAR with SFM group, in 8 patients (8.5 %, 8/94) in LAR without SFM group, and in 1 patient in pull-through rectal resection group (5 %, 1/20), p=0.17. Conclusions. Using the laparoscopic approach to SFM, optimal surgical outcomes can be achieved. Routine SFM during low anterior rectal resection is not necessary, because it does not lead to decreased incidence of anastomotic leakage and complications. Routine SFM during pull-through rectal resection is necessary.
Highlights
Splenic flexure mobilization (SFM) is a difficult step within both conventional and laparoscopic procedures, often associated with intra- and postoperative morbidity
The routine SFM during low rectal resections remains controversial
This paper presents the strategy for SFM used in our clinic, as well as the surgical treatment outcomes in patients who underwent low rectal resections with or without SFM
Summary
Рутинная мобилизация селезеночного изгиба при низких передних резекциях прямой кишки не является обязательной, так как не приводит к снижению частоты несостоятельности анастомозов и осложнений. Есть мнение, что при низкой резекции прямой кишки следует начинать операцию с МСИ до перехода к ТМЕ, так как этот этап сложнее и требует большей концентрации хирурга [2, 11]. Katory et al [2] при оценке отдаленных 6-летних результатов после передней резекции прямой кишки показано, что отказ от выполнения МСИ не влияет на онкологические результаты – не получено различий в количестве удаленных лимфоузлов (p=0,212) и в показателях. Частота несостоятельности анастомоза при резекциях прямой кишки с МСИ и без применения этой методики, по данным литературы
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