Mobilization of the Splenic Flexure: A Standard in Laparoscopic Left Colon and Rectum Resections!

The importance of routine mobilization of the left flexure within laparoscopic resections of the left colon is discussed controversially. In the opinion, it should be applied as a standard in these surgical operations. The data of the prospective evaluation of all laparoscopic colectomies were evaluated for a period between 1993 and 2005 with 1091 resections of the left colon or rectum with 72 conversions to an open procedure (conversion rate 6.6%) included. The left flexure was mobilized in 79.2% of all operations. There were no significant differences between the groups regarding the duration, loss of blood and other parameters. The anastomotic leakage rate was 2.2% in this study. A number of resection-rectopexies were included in the percentage of interventions without mobilization of the flexure. The mobilization of the left flexure can be applied as a routine part of left colic resections in a teaching hospital with a large number of participating surgeons and procedures. Using a standardized operation technique with subtle preparation and partially extreme positions of the patient during surgery the mobilization is possible without relevant loss of time and without increased complication rate and a remarkably low leakage rate.