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Ann R Coll Surg Engl. 2009 May; 91(4): 360.
PMCID: PMC2749435

Support for the Selective Approach to Splenic Flexure Mobilisation

I have read with interest the argument for and against routine mobilisation of the splenic flexure in anterior resection for cancer. In our practice, the decision to mobilise the splenic flexure for left colonic or anterior resections is made easy; most of our patients (females more than males) have redundant left and sigmoid colons and the incidence of diverticular disease is rare. After division of the inferior mesenteric artery just distal to the left colic artery, the colon can be brought down to the pelvis without tension or compromised vascularity. Only on some rare occasions was the mobilisation deemed necessary to avoid tension at the anastomotic site. What was used to be practiced in open surgery is now translated even more precisely and efficiently during laparoscopic colonic resection. Based on this, I totally support (at least in our population) the selective approach to splenic flexure mobilisation which was advocated and argued for by Kennedy and Jenkins.

In my modest experience with 25 left hemicolectomies and anterior resections that were performed either laparoscopically (n = 10) or hand-assisted (n = 15), none needed formal mobilisation of the splenic flexure. Moreover, there were no conversions and neither anastomotic leaks nor strictures.

Articles from Annals of The Royal College of Surgeons of England are provided here courtesy of The Royal College of Surgeons of England