title: Location is everything: The role of splenic flexure mobilization during colon resection for diverticulitis.
abstract: BACKGROUND
  Routine splenic flexure mobilization (SFM) has been previously recommended to ensure an adequate length for a tension free anastomosis during resection for diverticulitis. We sought to evaluate the role of selective SFM for diverticulitis, and its impact on outcomes.
  
  
  METHODS
  Retrospective review of elective colectomies at a tertiary care center (2007-2015) for left-sided diverticulitis were identified from the National Surgical Quality Improvement Program. Demographics and perioperative characteristics were compared; and 30-day risk-adjusted outcomes were assessed.
  
  
  RESULTS
  We identified 208 sigmoid/left colectomy cases. A laparoscopic approach predominated (71%), and SFM was performed in 54% of cases (n = 113). Demographics and comorbidities were similar. Median operative time was greater in the SFM group [226; interquartile range (IQR): (190-267) minutes] compared to no mobilization [180; IQR: (153-209) minutes] (p < 0.01). After risk adjustment, SFM was associated with a trend towards an increased rate of a minor morbidity (OR: 2.8; p = 0.05).
  
  
  CONCLUSIONS
  Splenic flexure mobilization was performed selectively in half of colectomies evaluated. This technique was associated with a trend towards an increased rate of minor complications, with no difference in major adverse events, including organ space infections. These findings suggest that for patient with diverticulitis, SFM should be performed in an individualized fashion.
authors.affiliation: Division of Colon and Rectal Surgery, University of Massachusetts Memorial Medical Center, 67 Belmont Street # 201F, Worcester, MA 01605, USA. Electronic address: Andrew.t.schlussel@gmail.com.
authors.forename: Andrew T
authors.initials: AT
authors.lastname: Schlussel
authors.affiliation: Division of Colon and Rectal Surgery, University of Massachusetts Memorial Medical Center, 67 Belmont Street # 201F, Worcester, MA 01605, USA. Electronic address: Jason.Wiseman@umassmemorial.org.
authors.forename: Jason T
authors.initials: JT
authors.lastname: Wiseman
authors.affiliation: Division of Colon and Rectal Surgery, University of Massachusetts Memorial Medical Center, 67 Belmont Street # 201F, Worcester, MA 01605, USA. Electronic address: John.kelly7@umassmemorial.org.
authors.forename: John F
authors.initials: JF
authors.lastname: Kelly
authors.affiliation: Division of Colon and Rectal Surgery, University of Massachusetts Memorial Medical Center, 67 Belmont Street # 201F, Worcester, MA 01605, USA. Electronic address: Jennifer.Davids@umassmemorial.org.
authors.forename: Jennifer S
authors.initials: JS
authors.lastname: Davids
authors.affiliation: Division of Colon and Rectal Surgery, University of Massachusetts Memorial Medical Center, 67 Belmont Street # 201F, Worcester, MA 01605, USA. Electronic address: justin.maykel@umassmemorial.org.
authors.forename: Justin A
authors.initials: JA
authors.lastname: Maykel
authors.affiliation: Division of Colon and Rectal Surgery, University of Massachusetts Memorial Medical Center, 67 Belmont Street # 201F, Worcester, MA 01605, USA. Electronic address: Paul.Sturrock3@umassmemorial.org.
authors.forename: Paul R
authors.initials: PR
authors.lastname: Sturrock
authors.affiliation: Division of Colon and Rectal Surgery, University of Massachusetts Memorial Medical Center, 67 Belmont Street # 201F, Worcester, MA 01605, USA. Electronic address: W.Brian.Sweeney@umassmemorial.org.
authors.forename: William B
authors.initials: WB
authors.lastname: Sweeney
authors.affiliation: Division of Colon and Rectal Surgery, University of Massachusetts Memorial Medical Center, 67 Belmont Street # 201F, Worcester, MA 01605, USA. Electronic address: Karim.Alavi@umassmemorial.org.
authors.forename: Karim
authors.initials: K
authors.lastname: Alavi
mesh_terms: D000714:Anastomosis, Surgical / Q000009:adverse effects / Q000379:methods; D003082:Colectomy / Q000009:adverse effects / Q000379:methods*; D044684:Colon, Transverse / Q000601:surgery*; D015897:Comorbidity; D004238:Diverticulitis / Q000601:surgery*; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012189:Retrospective Studies
keywords: Diverticulitis; Outcomes; Splenic flexure mobilization