Fundamentals of Rectal Cancer Surgery
Splenic Flexure Mobilization
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Splenic flexure mobilization is often needed for a tension free colorectal anastomosis, especially for a low or coloanal anastomosis.[1] The 4 important maneuvers required for complete splenic flexure mobilization are:
- Division of the lateral splenic flexure attachments to the side wall
- Careful division of the splenocolic attachments with gentle traction
- Separating the omentum from the distal transverse colon and splenic flexure
- Complete mobilization of the distal transverse colon and descending colon mesentery off of the retroperitoneum.
Three approaches to splenic flexure release will be discussed below:[2]
- Supramesocolic (or anterior) approach through the gastrocolic ligament
- Inframesocolic (or medial) approach (Figure 4.1)
- Lateral approach (Figure 4.2)
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Splenic flexure mobilization is often needed for a tension free colorectal anastomosis, especially for a low or coloanal anastomosis.[1] The 4 important maneuvers required for complete splenic flexure mobilization are:
- Division of the lateral splenic flexure attachments to the side wall
- Careful division of the splenocolic attachments with gentle traction
- Separating the omentum from the distal transverse colon and splenic flexure
- Complete mobilization of the distal transverse colon and descending colon mesentery off of the retroperitoneum.
Three approaches to splenic flexure release will be discussed below:[2]
- Supramesocolic (or anterior) approach through the gastrocolic ligament
- Inframesocolic (or medial) approach (Figure 4.1)
- Lateral approach (Figure 4.2)
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