title: [Medial mobilisation of the left hemicolon].
abstract: BACKGROUND
  Laparoscopic surgery of the colon is becoming more and more popular. However, regarding sigmoid resection, controversy remains concerning the extent of mobilisation, particularly regarding the splenic flexure. We developed a technique for anterior resection that meets all surgical standards: the anterior approach.
  
  
  METHODS
  From October 1999 to March 2001, 50 patients with benign diseases of the colon underwent laparoscopically assisted sigmoid resection. A completely anterior approach for mobilisation of the left hemicolon was used in all cases. Positioning the patients in Trendelenburg position on the extreme right side enabled primary ligation of the inferior mesenteric vein and artery as well as complete mobilisation of the splenic flexure from the middle. A transanal circular stapling device was used to reanastomose the colon 10-12 cm from the anus.
  
  
  RESULTS
  There were conversion and complication rates of 10% each, and three patients needed to be reoperated. The median operating time was 180 min. Patients could be dismissed on the 14th postoperative day.
  
  
  CONCLUSIONS
  To establish an operative standard, this technique has so far been used only for benign colon diseases. According to our experience, we think that it meets all oncological standards. Use of this technique in the treatment of malignant diseases seems therefore justified.
authors.affiliation: Klinik für Chirurgie, Kantonsspital St. Gallen, St. Gallen, Schweiz.
authors.forename: A
authors.initials: A
authors.lastname: Sigel
authors.forename: A
authors.initials: A
authors.lastname: Zerz
authors.forename: B
authors.initials: B
authors.lastname: Mölle
authors.forename: J
authors.initials: J
authors.lastname: Knaus
authors.forename: M
authors.initials: M
authors.lastname: Zünd
authors.forename: M
authors.initials: M
authors.lastname: Thurnheer
authors.forename: T
authors.initials: T
authors.lastname: Clerici
authors.forename: J
authors.initials: J
authors.lastname: Lange
mesh_terms: D018253:Adenoma, Villous / Q000601:surgery; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical / Q000379:methods; D003106:Colon / Q000601:surgery*; D003108:Colonic Diseases / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011183:Postoperative Complications / Q000209:etiology / Q000601:surgery; D012002:Rectal Diseases / Q000601:surgery*; D012086:Reoperation; D012811:Sigmoid Neoplasms / Q000601:surgery; D013528:Surgical Staplers