title: Assessing the extent of colon lengthening due to splenic flexure mobilization techniques: a cadaver study.
abstract: BACKGROUND
  Failure of a colorectal anastomosis represents a life-threatening complication of colorectal surgery. Splenic flexure mobilization may contribute to reduce the occurrence of anastomotic complications due to technical flaws. There are no published reports measuring the impact of splenic flexure mobilization on the length of mobilized colon viable to construct a safe colorectal anastomosis.
  
  
  OBJECTIVE
  The aim of the present study was to determine the effect of two techniques for splenic flexure mobilization on colon lengthening during open left-sided colon surgery using a cadaver model.
  
  
  METHODS
  Anatomical dissections for left colectomy and colorectal anastomosis at the sacral promontory level were conducted in 20 fresh cadavers by the same team of four surgeons. The effect of partial and full splenic flexure mobilization on the extent of mobilized left colon segment was determined.
  
  
  METHODS
  University of Sao Paulo Medical School, Sao Paulo, SP, Brazil. Tertiary medical institution and university hospital.
  
  
  METHODS
  A team of four surgeons operated on 20 fresh cadavers.
  
  
  RESULTS
  The length of resected left colon enabling a tension-free colorectal anastomosis at the level of sacral promontory achieved without mobilizing the splenic flexure was 46.3 (35-81) cm. After partial mobilization of the splenic flexure, an additionally mobilized colon segment measuring 10.7 (2-30) cm was obtained. After full mobilization of the distal transverse colon, a mean 28.3 (10-65) cm segment was achieved.
  
  
  CONCLUSIONS
  Splenic flexure mobilization techniques are associated to effective left colon lengthening for colorectal anastomosis. This result may contribute to decision-making during rectal surgery and low colorectal and coloanal anastomosis.
authors.affiliation: Departamento de Gastroenterologia, Faculdade de Medicina, Universidade de São Paulo, SP, Brasil.
authors.forename: Sergio Eduardo Alonso
authors.initials: SE
authors.lastname: Araujo
authors.forename: Victor Edmond
authors.initials: VE
authors.lastname: Seid
authors.forename: Nam Jin
authors.initials: NJ
authors.lastname: Kim
authors.forename: Alexandre Bruno
authors.initials: AB
authors.lastname: Bertoncini
authors.forename: Sergio Carlos
authors.initials: SC
authors.lastname: Nahas
authors.forename: Ivan
authors.initials: I
authors.lastname: Cecconello
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical; D002102:Cadaver; D003082:Colectomy / Q000379:methods*; D003106:Colon / Q000601:surgery*; D044684:Colon, Transverse / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012007:Rectum / Q000601:surgery*