2019 General Surgery Presentations

Joshua Dilday, DO, Timothy Gilligan, DO, Clay Merritt, DO, Daniel Nelson, DO, Avery Walker, MD; William Beaumont Army Medical Center

Objective: Proponents of routine splenic flexure mobilization (SFM) during distal colon resection suggest this technique ensures a well-vascularized tension-free anastomosis and lowers the risk of anastomotic leak.  Data supporting this practice are lacking. Therefore, we sought to evaluate the impact of SFM on outcomes in distal colon resection.

Methods: Using the 2005-2016 NSQIP database and the 2012-2017 NSQIP colorectal database, 30,960 patients undergoing distal colon resection with colorectal anastomosis were identified (90% open; 10% laparoscopic). Among all patients, 8,821 (28%) had concomitant SFM. Patients were stratified by performance of SFM. Intraoperative and postoperative outcomes were compared.

Results: The overall 30-day complication rate was 24% with a greater frequency of overall complications occurring among patients undergoing SFM (26% vs 23%; p<0.05). Organ space infection (6% v. 5.3%; p<0.05) and superficial wound infection (9.5% v. 7.8%; p<0.05) were both more common following SFM. Furthermore, SFM was associated with significantly longer operative times (226 min vs 192 min; p<0.05). The use of SFM was not associated with any difference in anastomotic leak rate (4.6% vs. 4.4%; p=0.8) or management of anastomotic leak as defined in the NSQIP colorectal database.

Conclusion: Contrary to popular belief, splenic flexure mobilization in distal colon resection was not associated with reduced incidence of anatomic leak in this series. Conversely, the addition of this procedure increased frequencies of deep and superficial infections and was associated with increased operative times. Routine mobilization of the splenic flexure may add unnecessary risk without providing significant benefit.