Laparoscopic rectal resection without splenic flexure mobilization: a prospective study assessing anastomotic safety.

BACKGROUND/AIMS: It was hypothesized that a portion of the sigmoid colon and accompanying marginal artery can be preserved by omitting the complete mobilization of the splenic flexure, yet achieve safe anastomosis. This study was designed to compare the surgical safety of omitting splenic flexure mobilization during laparoscopic rectal surgery in patients with rectal cancer.

METHODOLOGY

Between September 2006 and January 2008, laparoscopic rectal resection was performed in 160 consecutive patients with rectosigmoid and rectal cancer. Five patients who underwent abdominoperineal resection (APR) were excluded from this analysis. Morbidity and mortality were recorded prospectively. Splenic flexure mobilization (SFM), anastomotic leakage, bleeding, and stricture rate were analyzed in this group.

RESULTS

The median operative time was 225 min. There were no operative mortalities. SFM was required in 7 patients (4.5%). Anastomotic leakage occurred in 13 patients (8.4%), anastomotic bleeding occurred in 4 patients (2.6%), and 3 patients (1.9%) had strictures. The median number of harvested lymph nodes was 19.

CONCLUSIONS

A portion of the sigmoid colon can be safely used as the proximal bowel segment for anastomosis during laparoscopic rectal surgery, and thus full mobilization of the splenic flexure can be omitted.