Sex differences in the splenic flexure

Brookes, Alastair; Macano, Caw; Stone, Taylor; Cheetham, Mark; Meecham, Lewis

doi:10.1308/rcsann.2017.0054

Cited by 6 publications

(4 citation statements)

References 8 publications

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“…Besides, it has been long believed that male gender is a risk factor for di cult SFM. In a study on patients preoperative CT ndings, it has been concluded that the splenic exure is higher and further from midline in men than in women, and this nding provides the hypothesis why SFM is more di cult in male patients (20). However, the current study does not support this hypothesis, and have not revealed any signi cant association between gender and SFM duration.…”

Section: Discussioncontrasting

confidence: 82%

Prediction and Outcomes of Splenic Flexure Mobilization Duration during Laparoscopic Distal Colectomy for Colorectal Cancer: An Analysis of Operation Videos

Akyol,

Arslan,

Kocak

et al. 2023

Preprint

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Purpose: Splenic flexure mobilization (SFM) is a challenging step during laparoscopic colorectal operations. This study aims to inspect the predicting measures and consequences of lengthened SFM duration during laparoscopic distal colorectal cancer surgery. Methods: Patients underwent elective laparoscopic anterior or low anterior resection (AR or LAR) for distal sigmoid or rectal cancer were included. Data were abstracted from a prospectively designed database. A blinded observer to the patients and procedures watched the operation videos and tiered the steps of the procedures into 5 as follows: 1) medial-to-lateral dissection, 2) pelvic dissection, 3) dissection of the white line, 4) SFM, and 5) stapling, resection, extraction of the specimen and anastomosis. Patient and disease related measures predicting SFM duration and consequences of lengthened SFM duration were investigated. Results: A total of 105 patients (62 male, 59%) treated with AR (n=41) or LAR (N=64) were included to the study. No other patient or disease related features, but patients’ body mass index (BMI), weight and height were found to be significant predicting measures for lengthened SFM duration (p=0.0086, p=0.002 and p=0.43, respectively). The duration of SFM was correlating with the intervals of steps 1 (p=0.0013), 3 (p=0.0088) and 5 (p=0.04) and total operation time (p<0.0001). Lengthened SFM did not worsen postoperative measures including complications, hospitalization period and early oncological outcomes. Conclusions: Patients’ BMI, weight and height are the predicting measures for SFM duration at the time of laparoscopic distal colectomies. SFM duration shows a strong correlation with the durations of almost all other steps and total operation time but does not affect perioperative measures. Trial registration: E-10840098-772.02-61604 2.2.2019

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Section: Discussioncontrasting

confidence: 82%

Prediction and Outcomes of Splenic Flexure Mobilization Duration during Laparoscopic Distal Colectomy for Colorectal Cancer: An Analysis of Operation Videos

Akyol,

Arslan,

Kocak

et al. 2023

Preprint

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“…Body height showed only a slight influence on these groups, whereas sex had a strong correlation. A previous study 12 reported that the splenic flexure was located more cranially and more laterally in men than in women in an analysis of 100 CT images. Although the present series showed also that the individuals in the lateral group were predominantly men, the cranial group had a distinct location pattern of cranial, dorsal or medial, with nearly the same proportion in male and female patients.…”

Section: Discussionmentioning

confidence: 90%

Classification of the colonic splenic flexure based on three-dimensional CT analysis

et al. 2021

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Background Mobilization of the splenic flexure can be a challenging surgical step in colorectal surgery. This study aimed to classify the splenic flexure based on the three-dimensional (3D) coordinates of the splenic hilum and left renal hilum. This classification was used to compare splenic flexure mobilization during colorectal resection. Methods CT images of patients with colorectal cancer treated between April 2018 and December 2019 were analysed retrospectively. 3D mutual positioning of the splenic flexure from the ligament of Treitz to the splenic hilum or the left renal hilum was used to classify patients into three groups using cluster analysis. The difference in the procedure time between groups was also analysed in a subset of patients undergoing laparoscopic colectomy with complete splenic flexure mobilization. Results Of 515 patients reviewed, 319 with colorectal cancers were included in the study and categorized based on the 3D coordinates of the splenic hilum and left renal hilum as caudal (100 patients), cranial (118) and lateral (101) positions. Male sex (P < 0.001), older age (P = 0.004) and increased bodyweight (P = 0.043) were independent characteristics of the lateral group in multiple logistic regression analysis. Thirty-four patients underwent complete splenic flexure mobilization during the study period; this took significantly longer (mean 78.7 min) in the lateral group than in the caudal and cranial groups (41.8 and 43.2 min respectively; P = 0.006). Conclusion Locating the splenic flexure using 3D coordinates could be helpful in predicting a longer duration for mobilization of the splenic flexure.

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“…We present a rare case of a retro‐pancreatic colonic splenic flexure 1,2 . The splenic flexure is the most superior and lateral section of the transverse colon related to the spleen 3 …”

Section: Figurementioning

confidence: 99%

“…1,2 The splenic flexure is the most superior and lateral section of the transverse colon related to the spleen. 3 A 69-year-old female underwent transanal endoscopic microscopic surgery to remove a 27 × 22 × 19 mm sessile rectal polyp. Histology confirmed a villous adenoma with high-grade dysplasia with a foci of invasion into the muscularis mucosae with one associated high-risk feature of lymphovascular invasion.…”

mentioning

confidence: 99%