Abstract
A surgeon must possess the knowledge and technical skill to obtain length following
a left-sided colorectal resection to perform a tension free anastomosis. The distal
target organ – either rectum or anus – is fixed in location, and therefore requires
surgeons to acquire mastery of proximal mobilization of the colonic conduit. Generally,
splenic flexure mobilization (SFM) provides adequate length. Surgeons benefit from
clearer understanding of the multiple steps involved in SFM as a result of improved
visualization and demonstration of the relevant anatomy – adjacent organs and the
attachments, embryologic planes, and mesenteric structures. Much may be attributed
to laparoscopic and robotic platforms which provided improved exposure and as a result,
development or refinement of novel approaches for SFM with potential advantages. Complete
mobilization draws upon the sum or combination of the varied approaches to accomplish
the goal. However, in the situation where extended resection is necessary or in the
case of re-operative surgery sacrificing either more proximal or distal large intestine
often occurs, the transverse colon or even the ascending colon represents the proximal
conduit for anastomosis. This challenging situation requires familiarity with special
maneuvers to achieve colorectal or coloanal anastomosis using these more proximal
conduits. In such instances, operative techniques such as either ileal mesenteric
window with retroileal anastomosis or de-rotation of the right colon (Deloyer's procedure)
enable the intestinal surgeon to construct such anastomoses and thereby avoid stoma
creation or loss of additional large intestine.
Keywords
colorectal anastomosis - length - tension-free
