Name of the Procedure:

Mobilization (take-down) of splenic flexure performed in conjunction with partial colectomy

Summary

Mobilization of the splenic flexure is a surgical procedure where the splenic flexure, a bend in the colon near the spleen, is freed from its attachments. This is performed in conjunction with a partial colectomy, which is the surgical removal of a portion of the colon. This additional step may be necessary to facilitate a more efficient and safe removal of the affected section of the colon.

Purpose

The purpose of mobilization of the splenic flexure is to ensure better access and increased mobility of the colon during a partial colectomy. It helps in removing diseased or cancerous sections more effectively and ensures that there is sufficient bowel length for reconnection or anastomosis.

Indications

• Colon cancer located near the splenic flexure.
• Diverticulitis affecting the descending colon or splenic flexure.
• Inflammatory bowel disease such as Crohn's disease that involves the splenic flexure.
• Recurrent abdominal pain due to chronic colonic conditions.

Preparation

• Patients may be required to fast for 8-12 hours before surgery.
• Bowel preparation, such as laxatives or enemas, might be necessary to clear the colon.
• Preoperative assessments, including blood work, imaging studies, and possible colonoscopy.
• Adjustments in medications, especially anticoagulants, under medical advice.

Procedure Description

1. Anesthesia: The patient is placed under general anesthesia.
2. Incision: A surgical incision is made either laparoscopically (minimally invasive) or through an open approach.
3. Mobilization: The surgeon carefully dissects around the splenic flexure to free it from its attachments.
4. Partial Colectomy: The diseased section of the colon is identified and removed.
5. Reconnection: The remaining healthy sections of the colon are reconnected.
6. Closure: Incisions are sutured closed and dressed appropriately.

Instruments such as surgical scalpels, retractors, and laparoscopic tools are utilized.

Duration

The procedure typically takes about 2 to 4 hours, depending on the complexity of the case.

Setting

The procedure is performed in a hospital operating room, often within the surgical department.

Personnel

• General surgeon or colorectal surgeon
• Anesthesiologist
• Surgical nurses and technicians

Risks and Complications

• Common risks: Infection, bleeding, and adverse reactions to anesthesia.
• Rare risks: Injury to surrounding organs (spleen, pancreas), deep vein thrombosis, and leakage from the surgical connection (anastomotic leak).

Benefits

• Effective removal of diseased colon segments.
• Alleviation of symptoms such as pain and bleeding.
• Improved long-term prognosis for conditions like cancer. Benefits are usually realized over several weeks to months following recovery.

Recovery

• Hospital stay of 3-7 days post-surgery.
• Gradual reintroduction of foods, starting with liquids.
• Pain management with prescribed medications.
• Physical activity restrictions and gradual return to normal activities over 4-6 weeks.
• Follow-up appointments to monitor recovery and manage any complications.

Alternatives

• Medication management: Might be less effective for severe cases.
• Complete colectomy: More extensive surgery with longer recovery.
• Endoscopic procedures: Limited to less severe cases.

Patient Experience

Patients will be under general anesthesia and will not feel anything during the procedure. Postoperatively, they may experience pain and discomfort, which can be managed with medications. They will usually start with a liquid diet and gradually progress to solid foods. Full recovery typically takes a few weeks, during which physical activity will be restricted based on medical advice.