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:

1. Division of the lateral splenic flexure attachments to the side wall
2. Careful division of the splenocolic attachments with gentle traction
3. Separating the omentum from the distal transverse colon and splenic flexure
4. 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)