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The 3 approaches to splenic flexure mobilization

G Dapri, MD, PhD, FACS, FASMBS, Hon FPALES, Hon SPCMIN, Hon BSS, Hon CBCD, Hon CBC NA Bascombe, MD GB Cadière, MD, PhD J Marks, MD, FACS, FASCRS
Epublication WebSurg.com, Jun 2017;17(06). URL: http://websurg.com/doi/vd01en4959

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Background: The mobilization of the splenic flexure during laparoscopic colorectal surgery can be a challenge, especially in anatomically difficult patients. In this video, the inframesocolic, the supramesocolic, and lateral-to-medial approaches are demonstrated.

Video: The first part of the video shows the inframesocolic approach where the opening of the transverse mesocolon, above the pancreatic body and tail, allows access to the lesser sac and the exposure of the spleen. The second part of the video shows the supramesocolic approach where reaching Gerota’s fascia allows the flexure to be taken down. The third part of the video shows the lateral-to-medial approach where opening the lesser sac allows the flexure to be mobilized.

Results: All three approaches are laparoscopically feasible and safe. The goal remains similar, that is to avoid anastomotic tension. The operative time for this step, during the entire colorectal procedure, is influenced by the patient’s characteristics (previous surgery, high splenic flexure, short mesentery, etc.) and obviously, by the surgeon’s learning curve.

Conclusions: The choice between the three approaches depends on the patient’s characteristics and on the surgeon’s habits.