Location is everything: The role of splenic flexure mobilization during colon resection for diverticulitis. (April 2017)

• Record Type: Journal Article
• Authors: Schlussel, Andrew T.; Wiseman, Jason T.; Kelly, John F.; Davids, Jennifer S.; Maykel, Justin A.; Sturrock, Paul R.; Sweeney, William B.; Alavi, Karim
• Is Part Of: International journal of surgery. Volume 40(2017)
• Page Start: 124
• Page End: 129
• Publication Date: 2017-04
• Subjects: Diverticulitis -- Splenic flexure mobilization -- Outcomes; Surgery -- Periodicals; Surgical Procedures, Operative -- Periodicals; 617.005
• DOI: 10.1016/j.ijsu.2017.02.094
• Languages: English
• ISSNs: 1743-9191

Abstract

Abstract: Introduction: 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. Materials and 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). Conclusion: 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. Highlights: Splenic flexure mobilization has been recommended for resection of diverticulitis. We evaluated the role for selective splenic flexure mobilization. Mobilization was associated with an increased rate of minor complications. Splenic flexure mobilization should be performed in an individualized fashion.