Affiliation:
1. Ellen Leifer Shulman and Steven Shulman Digestive Disease Center Cleveland Clinic Florida Weston Florida USA
2. Colorectal Surgery Unit, General Surgery Department Mansoura University Hospitals Mansoura Egypt
3. Department of Surgery and Transplantation Sheba Medical Center Ramat‐Gan Israel
4. Department of General Surgery, Hadassah Medical Organization and Faculty of Medicine Hebrew University of Jerusalem Jerusalem Israel
Abstract
AbstractAimSplenic flexure mobilization (SFM) is commonly performed during left‐sided colon and rectal resections. The aim of the present systematic review was to assess the outcomes of SFM in left‐sided colon and rectal resections and the risk factors for complications and anastomotic leak (AL).MethodThis study was a PRISMA‐compliant systematic review. PubMed, Scopus and Web of Science were searched for studies that assessed the outcomes of sigmoid and rectal resections with or without SFM. The primary outcomes were AL and total complications, and the secondary outcomes were individual complications, operating time, conversion to open surgery, length of hospital stay (LOS) and pathological and oncological outcomes.ResultsNineteen studies including data on 81 116 patients (49.1% male) were reviewed. SFM was undertaken in 40.7% of patients. SFM was associated with a longer operating time (weighted mean difference 24.50, 95% CI 14.47–34.52, p < 0.0001) and higher odds of AL (OR 1.19, 95% CI 1.06–1.33, p = 0.002). Both groups had similar odds of total complications, splenic injury, anastomotic stricture, conversion to open surgery, (LOS), local recurrence, and overall survival. A secondary analysis of rectal cancer cases only showed similar outcomes for SFM and the control group.ConclusionsSFM was associated with a longer operating time and higher odds of AL, yet a similar likelihood of total complications, splenic injury, anastomotic stricture, conversion to open surgery, LOS, local recurrence, and overall survival. These conclusions must be cautiously interpreted considering the numerous study limitations. SFM may have only been selectively undertaken in cases in which anastomotic tension was suspected. Therefore, the suboptimal anastomoses may have been the reason for SFM rather than the SFM being causative of the anastomotic insufficiencies.