Splenic flexure mobilization in left‐sided colonic and rectal resections: A meta‐analysis and meta‐regression of factors associated with anastomotic leak and complications

Emile, Sameh Hany; Dourado, Justin; Rogers, Peter; Horesh, Nir; Garoufalia, Zoe; Gefen, Rachel; Wexner, Steven D.

doi:10.1111/codi.16983

Colorectal Disease

2024

DOI: 10.1111/codi.16983

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Splenic flexure mobilization in left‐sided colonic and rectal resections: A meta‐analysis and meta‐regression of factors associated with anastomotic leak and complications

Sameh Hany Emile,

Justin Dourado,

Peter Rogers

et al.

Abstract: AimSplenic flexure mobilization (SFM) is commonly performed during left‐sided colon and rectal resections. The aim of the present systematic review was to assess the outcomes of SFM in left‐sided colon and rectal resections and the risk factors for complications and anastomotic leak (AL).MethodThis study was a PRISMA‐compliant systematic review. PubMed, Scopus and Web of Science were searched for studies that assessed the outcomes of sigmoid and rectal resections with or without SFM. The primary outcomes were … Show more

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Cited by 2 publications

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Operative time and surgical efficiency in end-to-end versus side-to-end colorectal anastomosis for rectal cancer

Haque,

Ovi,

Jalal

2024

Int Surg J

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Background: Side-to-end anastomosis (SEA) and end-to-end anastomosis (EEA) are widely used techniques in colorectal cancer surgery, yet their comparative outcomes remain a subject of debate. This study evaluates operative time, surgical efficiency, and functional outcomes of SEA versus EEA in patients undergoing low anterior resection for rectal cancer. Methods: A prospective observational study was conducted at Bangabandhu Sheikh Mujib Medical University, (BSMMU) Dhaka, from March to November 2023. Forty-four patients were purposively sampled and randomized into SEA and EEA groups. Intraoperative variables, postoperative outcomes, and functional results, including low anterior resection syndrome (LARS) scores, were evaluated at multiple intervals. Data were analyzed using SPSS version 25, with p<0.05 considered significant. Results: The ASA PS classification and preoperative tumor stages were similar across groups. Splenic flexure mobilization was universally performed in SEA (100%) and in 90.9% of EEA patients (p=0.385). Blood loss was comparable between groups (<100 mL in 90.9% of SEA and 95.5% of EEA, p=0.157). Operative time was significantly longer in SEA (183.0±10.2 minutes) compared to EEA (151.0±12.8 minutes, p<0.05). Postoperative LARS scores revealed no significant differences, with major LARS observed in 39% of EEA patients and 61% of SEA patients (p>0.05). Anastomotic line bleeding was infrequent in both groups, with no statistically significant differences. Conclusions: Both SEA and EEA demonstrated comparable safety and functional outcomes in rectal cancer surgery. SEA was associated with longer operative times but offered similar functional and surgical efficiency. The findings highlight the viability of both techniques, with the choice depending on patient-specific and surgical considerations.

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Operative time and surgical efficiency in end-to-end versus side-to-end colorectal anastomosis for rectal cancer

Haque,

Ovi,

Jalal

2024

Int Surg J

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Oncological and Clinical Impacts of Routine Splenic Flexure Mobilization in Anterior Resection

Syed,

Hasan,

Badawi

et al. 2024

Cureus

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Background Splenic flexure mobilization (SFM) is widely regarded as one of the most challenging steps in laparoscopic and robotic colorectal surgery, sparking ongoing debate. Some surgeons routinely advocate for SFM, citing its role in achieving greater left colonic reach, which facilitates a safe, tension-free, and well-vascularized anastomosis while adhering to oncological principles. Conversely, others argue that SFM does not consistently ensure these benefits and may increase the risk of complications, including splenic, bowel, or vascular injuries, as well as unnecessarily prolonging the procedure. While traditional surgical textbooks consider SFM a mandatory step in open colorectal resections, limited evidence supports its necessity in minimally invasive approaches. Aim This study aims to evaluate whether routinely mobilizing the splenic flexure offers advantages from both oncological and clinical perspectives. Materials and methods This retrospective cohort study evaluated the oncological and clinical outcomes of SFM versus splenic flexure preservation (SFP) in anterior resections for malignant pathologies. The study was conducted at New Cross Hospital in Wolverhampton, United Kingdom, over a 24-month period, from March 2022 to March 2024. Anterior resections for benign pathologies were excluded. Data analysis was performed using IBM SPSS Statistics for Windows, Version 24.0 (Released 2016; IBM Corp., Armonk, NY, USA) and Microsoft Excel (Microsoft Corporation, Redmond, WA, USA). Results This study included 94 patients, with 65 undergoing SFM and 29 having it preserved (SFP). No significant differences in baseline demographics (age and gender) were observed between the groups. Oncological outcomes revealed a significantly longer median length of resected specimens in the SFM group, although lymph node counts and high vascular ties were comparable between the groups. There were no differences in R0 resection rates. Clinical outcomes showed similar hospital stays and operation durations in both groups. The SFM group had a slightly higher rate of stoma formation but a lower incidence of anastomotic leaks compared to the SFP group. No significant differences in splenic injuries or other complications were noted. Conclusions Our study suggests that routine SFM offers certain oncological and clinical benefits. The specimens obtained were more complete for pathological staging. The additional length gained from the maneuver not only results in longer specimens but also provides sufficient mobility of the remaining colon, enabling anastomosis with minimal tension, which helps prevent anastomotic leaks. Surgeons may consider adjusting their practices based on the findings of this study.

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Splenic flexure mobilization in left‐sided colonic and rectal resections: A meta‐analysis and meta‐regression of factors associated with anastomotic leak and complications

Cited by 2 publications

References 52 publications

Operative time and surgical efficiency in end-to-end versus side-to-end colorectal anastomosis for rectal cancer

Operative time and surgical efficiency in end-to-end versus side-to-end colorectal anastomosis for rectal cancer

Oncological and Clinical Impacts of Routine Splenic Flexure Mobilization in Anterior Resection

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