Unveiling the hidden: identification and management of overlooked blood vessels in laparoscopic left hemicolectomy for splenic flexure cancer

BMC Surg. 2024 Apr 27;24(1):128. doi: 10.1186/s12893-024-02424-0.

Abstract

Background: During laparoscopic left hemicolectomy procedures, a previously overlooked consistently thick blood vessel within the gastrocolic ligament near the splenic hilum may contribute to post-operative bleeding complications. The purpose of this study was to investigate the identification and management of the previously overlooked blood vessel.

Methods: This is a retrospective descriptive study of patients undergoing laparoscopic left colectomy for splenic fexure cancer conducted at a national gastrointestinal surgery centre in China. Consecutive patients with splenic fexure cancer who underwent laparoscopic left colectomy using our"five-step process"(n = 34) between January 2021 and July 2023 were included.

Results: The vessels can be effectively exposed using the aforementioned "five-step process." It was observed that the overlooked vessels consistently present in all patients were identified as the omental branch of the left gastroepiploic artery and vein.

Conclusion: We have identified the origin of previously overlooked blood vessels and recommended a safe method for their management. This may offer advantages to colorectal surgeons performing laparoscopic left colectomy for splenic flexure cancer.

Keywords: Laparoscopic left hemicolectomy; Overlooked blood vessels; Splenic flexure cancer.

MeSH terms

  • Adult
  • Aged
  • China
  • Colectomy* / methods
  • Colon, Transverse / blood supply
  • Colon, Transverse / surgery
  • Colonic Neoplasms / surgery
  • Female
  • Humans
  • Laparoscopy* / methods
  • Male
  • Middle Aged
  • Postoperative Hemorrhage / etiology
  • Retrospective Studies