A 6‐year review of surgical morbidity and oncological outcome after high anterior resection for colorectal malignancy with and without splenic flexure mobilization

Abstract

No morbidity, oncological or survival disadvantage in performing splenic flexure preserving HAR was found.

Surgeons lack predictive accuracy for anastomotic leakage in gastrointestinal surgery

“…In general, the global, clinical judgement seems to localize a subset of patients at risk for developing complications in general, whereas many patients with no risk factors at all may develop anastomotic leakage [12]. The risk factors for anastomotic leakage identified by univariate and multivariate analysis in our study corroborate with those found in other studies [1][2][3][4][5][6][7][8]. Similar to these studies, the number of risk factors present in an individual patient appeared to be an important predictor of anastomotic leakage in all anastomoses.…”

“…Clinically relevant anastomotic leakage rates range between 3% and 19% [1,[3][4][5][6][7][8][9]. Anastomotic leakage may remain localized, causing perianastomotic inflammation or abscess formation, or may progress to generalised peritonitis.…”

The selective use of splenic flexure mobilization is safe in both laparoscopic and open anterior resections

“…[4] who analysed the results of 707 open HARs, of which 531 (75%) were deemed at surgery to require SFM. Drawing the evidence together, routine mobilization of the splenic flexure during open anterior resection should probably be abandoned in favour of a selective approach.…”

An extended medial to lateral approach to mobilize the splenic flexure during laparoscopic low anterior resection

“…The right lateral approach for laparoscopic SFM was recently introduced to ensure a safe, rapid and complete mobilization of the splenic flexure . Some surgeons recommend that SFM should be performed only when there is tension at the anastomosis . While we agree with this recommendation, our policy is that SFM is a routine step during low anterior resection because it requires only 15–20 min more operation time than not performing it.…”