title: Different approaches for complete mobilization of the splenic flexure during laparoscopic rectal cancer resection.
abstract: OBJECTIVE
  Laparoscopic resection of rectal cancer has already become the standard procedure in many hospitals. The splenic flexure mobilization (SFM) is an important preparational step. Several methods are used for laparoscopic SFM; however, studies comparing different approaches are lacking. In the present study, three different approaches for SFM have been compared to each other.
  
  
  METHODS
  Between January 1998 and December 2010, 415 patients with rectal adenocarcinoma underwent laparoscopic rectal resection at one center. Of these, 303 patients received complete splenic flexure mobilization. The SFM was performed using either a medial (SFM-M; n = 41), lateral (SFM-L; n = 214), or anterior (SFM-A; n = 48) approach.
  
  
  RESULTS
  There was a significantly higher rate of intraoperative complications in the SFM-L group as compared to the SFM-M or the SFM-A group (p = 0.038). Postoperative surgical complications occurred in 5 (10.6 %) patients of the SFM-A group compared to 38 patients (17.7 %) in the SFM-L group (p = 0.002) and 5 (12.1 %) patients in the SFM-M group (p = 0.037). SFM-L was also associated with a higher frequency of overall postoperative morbidity which was mainly due to wound infection rates (p = 0.001).
  
  
  CONCLUSIONS
  The anterior approach for SFM in laparoscopic surgery seems to be associated with lower frequency of intra- and postoperative morbidity.
authors.affiliation: Department of Surgery, University Medical Center Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany. vbenseler@gmail.com
authors.forename: Volker
authors.initials: V
authors.lastname: Benseler
authors.forename: Matthias
authors.initials: M
authors.lastname: Hornung
authors.forename: Igors
authors.initials: I
authors.lastname: Iesalnieks
authors.forename: Philipp
authors.initials: P
authors.lastname: von Breitenbuch
authors.forename: Gabriel
authors.initials: G
authors.lastname: Glockzin
authors.forename: Hans J
authors.initials: HJ
authors.lastname: Schlitt
authors.forename: Ayman
authors.initials: A
authors.lastname: Agha
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D044684:Colon, Transverse / Q000601:surgery*; D013505:Digestive System Surgical Procedures / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006801:Humans; D007430:Intraoperative Care; D007431:Intraoperative Complications / Q000209:etiology; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011300:Preoperative Care; D012004:Rectal Neoplasms / Q000473:pathology / Q000601:surgery*