Our Summary

This research paper is about a medical procedure called splenic flexure mobilization (SFM), which is often carried out during surgeries involving the left side of the colon and rectum. The researchers wanted to see what the results of SFM are, particularly in terms of complications and a specific issue known as anastomotic leak (AL), which is when the join line between two sections of the bowel leaks.

To do this, they carried out a systematic review of existing studies, which is a way of gathering and evaluating all available research on a particular topic. They found 19 studies involving over 81,000 patients, nearly half of whom were male. They found that SFM was used in roughly 40% of these patients.

The results showed that SFM was linked to longer operation times and a higher chance of anastomotic leak. However, it didn’t seem to make any difference to the overall number of complications, the chance of injuring the spleen, the risk of the bowel join line becoming too narrow (anastomotic stricture), the need to switch to open surgery, the length of the hospital stay, or the chances of the cancer coming back or affecting survival.

However, the researchers warned that these findings need to be taken with caution because of limitations in the studies they reviewed. For instance, it’s possible that SFM was only used in cases where there was already a suspected risk of anastomotic tension (strain on the join line), so the procedure itself might not be to blame for the increased risk of leakage.

FAQs

  1. What is the purpose of splenic flexure mobilization (SFM) in surgeries involving the left side of the colon and rectum?
  2. What were the results of the systematic review on SFM and its implications on complications and anastomotic leak?
  3. What are the potential limitations of the studies reviewed on SFM?

Doctor’s Tip

Overall, a doctor might advise a patient undergoing a proctectomy to be aware of the potential risks associated with splenic flexure mobilization, such as longer operation times and a higher chance of anastomotic leak. It’s important for patients to discuss these risks with their healthcare team and to follow post-operative care instructions closely to minimize complications.

Suitable For

Patients who are typically recommended for proctectomy, which may involve splenic flexure mobilization as a part of the surgery, include those with conditions such as inflammatory bowel disease, colorectal cancer, familial adenomatous polyposis, ulcerative colitis, or other conditions that affect the colon and rectum. These patients may require surgery to remove part or all of the colon and rectum, and a proctectomy may be necessary in order to improve their quality of life and overall health.

Timeline

Before a proctectomy, a patient may experience symptoms such as rectal bleeding, changes in bowel habits, abdominal pain, or a feeling of incomplete emptying of the bowels. They may undergo diagnostic tests such as colonoscopy or imaging studies to confirm the need for surgery.

After a proctectomy, the patient will experience a recovery period in the hospital, during which they may have a temporary colostomy or ileostomy to allow the bowel to heal. They will gradually resume eating and drinking, start moving around, and receive pain management as needed.

In the long term, the patient may experience changes in bowel function, such as increased frequency or urgency of bowel movements. They may need to make dietary changes or take medications to manage these symptoms. Regular follow-up appointments with the surgical team will be necessary to monitor for any complications and ensure proper healing.

What to Ask Your Doctor

  1. What is the purpose of splenic flexure mobilization (SFM) during a proctectomy?

  2. What are the potential complications or risks associated with SFM?

  3. How does SFM impact the likelihood of anastomotic leak (AL) following surgery?

  4. Are there any alternative surgical techniques or approaches that could be considered instead of SFM?

  5. What is the recovery process like for patients who undergo SFM during a proctectomy?

  6. How will SFM affect my long-term outcomes or prognosis following surgery?

  7. Are there any specific factors about my individual case that make SFM more or less advisable?

  8. How experienced are you in performing SFM during proctectomy procedures?

  9. What steps will be taken to minimize the risks associated with SFM during my surgery?

  10. Are there any specific lifestyle changes or precautions I should take after undergoing SFM during a proctectomy?

Reference

Authors: Emile SH, Dourado J, Rogers P, Horesh N, Garoufalia Z, Gefen R, Wexner SD. Journal: Colorectal Dis. 2024 Jul;26(7):1332-1345. doi: 10.1111/codi.16983. Epub 2024 May 17. PMID: 38757843