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Laparoscopic Splenic Flexure Mobilization Using a Medial Approach

대한대장항문학회지 2006년 22권 4호 p.250 ~ 254
김형란 ( Kim Hyoung-Ran ) - 가톨릭대학교 의과대학 외과학교실

이윤석 ( Lee Yoon-Suk ) - 가톨릭대학교 의과대학 외과학교실
이인규 ( Lee In-Kyu ) - 가톨릭대학교 의과대학 외과학교실
김진조 ( Kim Jin-Jo ) - 가톨릭대학교 의과대학 외과학교실
이근호 ( Lee Keun-Ho ) - 가톨릭대학교 의과대학 외과학교실
오세정 ( Oh Se-Jung ) - 가톨릭대학교 의과대학 외과학교실
박승만 ( Park Seung-Man ) - 가톨릭대학교 의과대학 외과학교실
오승택 ( Oh Seung-Tack ) - 가톨릭대학교 의과대학 외과학교실
김준기 ( Kim Jun-Gi ) - 가톨릭대학교 의과대학 외과학교실
김영하 ( Kim Young-Ha ) - 가톨릭대학교 의과대학 외과학교실

Abstract


Purpose: Splenic flexure mobilization in an anterior resection is a subject of controversy, but a tension-free anastomosis is needed in case of a low anterior resection or a coloanal anastomosis. Classical splenic flexure mobilization by means of the lesser sac opening is technically difficult in the laparoscopic era.

Methods: This study retrospectively analyzed the medical records and operation videos of 16 patients who underwent laparoscopic splenic flexure mobilization in Our Lady of Mercy Hospital, The Catholic University of Korea by using a medial approach. The operation procedure is as follows: Under general anesthesia, the patient was placed in the Trendelenburg position, after making pneumoperitoneum, the inferior mesenteric artery (IMA) and the inferior mesenteric vein (IMV) were ligated and divided. A medial-to-lateral mesocolon dissection was done, and the pancreas was dissected from the mesocolon of the transverse colon; then, the greater omentum was dissected.

Results: The mean age was 60 years old, and the male- to-female sex ratio was 9:7. The mean operation time was 293 minutes. The mean distal margin was 5.3 cm, and the mean number of harvested lymph nodes was 15. An anterior resection was done in 2 cases, a low anterior resection is 10 cases, and a coloanal anastomosis in 4 cases. The mean time from ligation of the IMA to splenic flexure mobilization was 45 minutes. There was no mortality or morbidity.

Conclusions: Laparoscopic medial splenic flexure mobilization is a technically feasible and safe method. J Korean Soc Coloproctol 2006;22:250-254

키워드

복강경;비장만곡부 박리
Laparoscopy;Splenic flexure mobilization
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