Faculty Collaboration Database

Examining Utility of Routine Splenic Flexure Mobilization during Colectomy and Impact on Anastomotic Complications. Am J Surg 2020 Jun;219(6):998-1005

Date

08/04/2019

Pubmed ID

31375246

DOI

10.1016/j.amjsurg.2019.07.030

Scopus ID

2-s2.0-85069902072 (requires institutional sign-in at Scopus site)   6 Citations

Abstract

BACKGROUND: Despite a lack of supporting data, routine splenic flexure mobilization (SFM) during colectomy has been thought to reduce anastomotic leak (AL). We evaluated the impact of SFM on outcomes in distal colectomy.

STUDY DESIGN: The 2005-2016 NSQIP database identified 66,068 patients undergoing distal colectomy with anastomosis. Cohorts were stratified by addition of SFM. Postoperative outcomes were compared between groups. Regression analysis identified factors affecting odds of developing AL.

RESULTS: SFM was performed in 27,475 patients (41.6%). There was no difference in overall complications between cases with SFM and those without (p = 0.55). SFM had longer operative times (220 min vs. 184 min; p < 0.0001). SFM was not associated with any difference in AL rate (3.6% vs. 3.7%; p = 0.86). Factors most associated with AL were lack of oral antibiotic preparation (OR 1.93; p < 0.001), chemotherapy (OR 1.91; p < 0.001), and weight loss (OR 1.68; p = 0.0005). Operative indication and approach did not affect leak.

CONCLUSIONS: SFM in distal colectomy increased operative time without decreasing overall complications or AL. Routine splenic flexure mobilization may add risk without significant benefit.

Author List

Dilday JC, Gilligan TC, Merritt CM, Nelson DW, Walker AS

Author

Joshua C. Dilday DO Adjunct Assistant Professor in the Surgery department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Aged
Anastomosis, Surgical
Anastomotic Leak
Colectomy
Female
Humans
Intraoperative Care
Male
Middle Aged
Retrospective Studies
Spleen