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Chugh P, Eble D, He K, Sacks O, Madiedo A, Whang E, Kristo G. Evaluation of Operative Notes for Splenic Flexure Mobilization: Are the Key Aspects Being Reported? J Laparoendosc Adv Surg Tech A 2021; 32:270-276. [PMID: 33960832 DOI: 10.1089/lap.2021.0067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: Given the importance of operative documentation, we reviewed operative notes for surgeries that required splenic flexure mobilization (SFM) to determine their accuracy. Materials and Methods: We performed a retrospective review of 51 operative notes for complete SFMs performed at a single institution from January 2015 to June 2020. Results: None of the operative notes reported a rationale for performing SFM, use of preoperative imaging to guide technical approach, reasoning for the operative method and mobilization approach used, or specific steps taken to ensure that SFM was done safely. Most reports did not include technical details, with one-third of the notes merely reporting that "the splenic flexure was mobilized." Conclusions: Increased awareness about the lack of operative documentation of the critical aspects of the SFM could stimulate initiatives to standardize the SFM method and improve the quality of operative notes for SFM.
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Affiliation(s)
- Priyanka Chugh
- Department of Surgery, Veterans Affairs Boston Healthcare System, Boston, Massachusetts, USA.,Department of Surgery, Boston Medical Center, Boston University Medical School, Boston, Massachusetts, USA
| | - Danielle Eble
- Department of Surgery, University of Washington, Seattle, Washington, USA
| | - Katherine He
- Department of Surgery, Veterans Affairs Boston Healthcare System, Boston, Massachusetts, USA.,Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Olivia Sacks
- Department of Surgery, Veterans Affairs Boston Healthcare System, Boston, Massachusetts, USA.,Department of Surgery, Boston Medical Center, Boston University Medical School, Boston, Massachusetts, USA
| | - Andrea Madiedo
- Department of Surgery, Veterans Affairs Boston Healthcare System, Boston, Massachusetts, USA.,Department of Surgery, Boston Medical Center, Boston University Medical School, Boston, Massachusetts, USA
| | - Edward Whang
- Department of Surgery, Veterans Affairs Boston Healthcare System, Boston, Massachusetts, USA.,Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Gentian Kristo
- Department of Surgery, Veterans Affairs Boston Healthcare System, Boston, Massachusetts, USA.,Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Brookes AF, Macano C, Stone T, Cheetham M, Meecham L. Sex differences in the splenic flexure. Ann R Coll Surg Engl 2017; 99:456-458. [PMID: 28660812 DOI: 10.1308/rcsann.2017.0054] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Anecdotally, surgeons claim splenic flexure mobilisation is more difficult in male patients. There have been no scientific studies to confirm or disprove this hypothesis. The implications in colorectal surgery could be profound. The aim of this study was to assess quantitatively whether there is an anatomical difference in the position of the splenic flexure between men and women using computed tomography (CT). METHODS Portal venous phase CT performed for preoperative assessment of colorectal malignancy was analysed using the hospital picture archiving and communication system. The splenic flexure was compared between men and women using two variables: anatomical height corresponding to the adjacent vertebral level (converted to ordinal values between 1 and 17) and distance from the midline. RESULTS In total, 100 CT images were analysed. Sex distribution was even. The mean ages of the male and female patients were 68.1 years and 66.7 years respectively (p=0.630). The mean vertebral level for men was 8.88, equating to the inferior half of the T11 vertebral body (range: 1-17 [superior half of T9 to inferior half of L2]), and 11.36 for women, equating to the inferior half of the T12 vertebral body (range: 4-16 [superior half of T10 to superior half of L2]). This difference was statistically significant (p=0.0001) and is equivalent to one whole vertebra. The mean distance from the midline was 160.8mm (range: 124-203mm) for men and 138.2mm (range: 107-185mm) for women (p<0.0001). CONCLUSIONS The splenic flexure is both higher and further from the midline in men than in women. This provides one theory as to why mobilising the splenic flexure may be more difficult in male patients.
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Affiliation(s)
| | - Caw Macano
- Heart of England NHS Foundation Trust , UK
| | - T Stone
- Shrewsbury and Telford Hospital NHS Trust , UK
| | - M Cheetham
- Shrewsbury and Telford Hospital NHS Trust , UK
| | - L Meecham
- Heart of England NHS Foundation Trust , UK
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