What is mobilization of the colon?
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Kye BH, Kim HJ, Kim HS, Kim JG, Cho HM. 2014. How Much Colonic Redundancy Could Be Obtained by Splenic Flexure Mobilization in Laparoscopic Anterior or Low Anterior Resection?. Int J Med Sci. 11(9):857-862. Show Although splenic flexure mobilization occasionally looks complicated, it consists of five simple procedures: 1, division of the line of Toldt (dividing the lateral peritoneal attachment); 2, division of the gastrocolic ligament (dividing the greater omentum and transverse colon, then entering the lesser sac); 3, division of the splenocolic ligament; 4, division of the phrenocolic ligament; 5, division of the pancreaticocolic ligament (division of the transverse mesocolon and inferior border of the pancreas). Based on the method of entering the lesser sac, laparoscopic splenic flexure mobilization can be categorized into three surgical approaches: A, anterior approach; B. inferio-medial approach; C. lateral approach. Patients were placed in the supine position with reverse Trendelenburg and right down tilting position. After completion of inferior mesenteric artery (IMA) and inferior mesenteric vein (IMV) ligation and medial to lateral mesocolic dissection, the author started splenic flexure mobilization. In the anterior approach, the lesser sac is entered from the anterior part by dividing the gastrocolic ligament first, while in the inferio-medial approach the lesser sac is entered from the inferior part by dividing the pancreaticocolic ligament first. In the lateral approach, the phrenocolic and splenocolic ligament is divided, after which the lesser sac is entered from the lateral part (see details invideo). Mobilization of right colon. Two graspers pull the right colon medially as the white line of Toldt is incised. 2,755 Share this:RelatedImage AuthorSAGES WebmasterUploaded on06/14/2010CategoryFundamentals: Segmental Colectomies, Anterior, SAGES ManualTagscolon, graspers, medially, mobilization, toldtDownloads5377If you have used this image in a publication or presentation please email [email protected] and let us know how it worked out. Location is everything: The role of splenic flexure mobilization during colon resection for diverticulitisAuthor links open overlay panelAndrew T.SchlusselD.O.EnvelopeJason T.WisemanM.D. M.S.P.H.EnvelopeJohn F.KellyM.D.EnvelopeJennifer S.DavidsM.D.EnvelopeJustin A.MaykelM.D.EnvelopePaul R.SturrockM.D.EnvelopeWilliam B.SweeneyM.D.EnvelopeKarimAlaviM.D. M.P.H.PersonEnvelope Show moreNavigate DownShareShare Cited ByCite https://doi.org/10.1016/j.ijsu.2017.02.094Get rights and content Under an Elsevier user license Open archive Highlights• Splenic flexure mobilization has been recommended for resection of diverticulitis. •We evaluated the role for selective splenic flexure mobilization. •Mobilization was associated with an increased rate of minor complications. Splenic flexure mobilization should be performed in an individualized fashion. AbstractIntroductionRoutine splenic flexure mobilization (SFM) has been previously recommended to ensure an adequate length for a tension free anastomosis during resection for diverticulitis. We sought to evaluate the role of selective SFM for diverticulitis, and its impact on outcomes. Materials and methodsRetrospective review of elective colectomies at a tertiary care center (2007–2015) for left-sided diverticulitis were identified from the National Surgical Quality Improvement Program. Demographics and perioperative characteristics were compared; and 30-day risk-adjusted outcomes were assessed. ResultsWe identified 208 sigmoid/left colectomy cases. A laparoscopic approach predominated (71%), and SFM was performed in 54% of cases (n = 113). Demographics and comorbidities were similar. Median operative time was greater in the SFM group [226; interquartile range (IQR): (190–267) minutes] compared to no mobilization [180; IQR: (153–209) minutes] (p < 0.01). After risk adjustment, SFM was associated with a trend towards an increased rate of a minor morbidity (OR: 2.8; p = 0.05). ConclusionSplenic flexure mobilization was performed selectively in half of colectomies evaluated. This technique was associated with a trend towards an increased rate of minor complications, with no difference in major adverse events, including organ space infections. These findings suggest that for patient with diverticulitis, SFM should be performed in an individualized fashion. What does mobilization of splenic flexure mean?Splenic flexure mobilization, which is an essential surgical procedure to elongate the left colon, is the only way to induce tension free anastomosis.
Why is a mobilization of splenic flexure done?Splenic flexure mobilization is often required for the creation of a tension-free anastomosis with good blood supply in patients undergoing ultra-low anterior resection for middle and lower rectal cancer. Moreover, SFM may even become mandatory in patients requiring a colonic pouch [28].
What are the side effects of a right hemicolectomy?Loose stool, increased bowel frequency and/or nocturnal defaecation following right-sided colectomy occurs in approximately one in five patients. Some of these symptoms may improve spontaneously with time. Bile acid malabsorption and/or small bowel bacterial overgrowth may be the cause for chronic dysfunction.
Why is hemicolectomy performed?Why is hemicolectomy performed? The usual reasons for hemicolectomy are bowel cancer, polyps, diverticulitis, inflammatory bowel disease or an abdominal injury.
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