Mobilization of the Splenic Flexure
Splenic flexure mobilization may be performed during low anterior resection, sigmoid colectomy, left colectomy, or total colectomy. In this chapter, we concentrate on the lateral approach, which is commonly performed during sigmoid colectomy. In the total colectomy chapter (see Chapter 17), we described the medial approach to the splenic flexure. In practice, the approach may be a combination of medial and lateral approaches.
KEY STEPS
1. Patient rotated to the right and slight reverse Trendelenburg.
2. Greater omentum reflected over the transverse colon and the small bowel moved to the right upper quadrant.
3. Division of lateral attachments of the descending colon to the retroperitoneum.
4. Enter the lesser sac.
5. Division of the avascular plane between the greater omentum and the transverse mesocolon.
6. Connecting avascular plane between the greater omentum and the transverse colon to the lateral dissection plane.
7. If a tumor is near the flexure, the greater omentum is taken en bloc off the gastroepiploic arcade.
ADDITIONAL ADVICE
1. Continuing the lateral dissection up toward the spleen, one must be careful not to go posterior into the retroperitoneum. As the flexure comes down, one can dissect the transverse mesocolon off the anterior and inferior border of the pancreas.