Lymphatic drainage follows the course of the inferior mesenteric vessels. The venous drainage of the sigmoid colon follows the arterial supply and venous blood is drained by the inferior mesenteric vein. The sigmoid colon receives its blood supply from the two to five sigmoidal branches of the inferior mesenteric artery, which is a branch of the abdominal aorta at 元. The sigmoid colon usually lies within the pelvis, but can be displaced into the abdomen due to its relatively mobile nature. Superior to it are loops of the ileum, and anterior to it are the bladder and uterus (in the female). It also lies anterior to the posterior abdominal wall (quadratus lumborum, iliacus, iliac crest). It runs in front of the sacrum, external iliac vessels, the left sacral plexus, left ureter, and the left piriformis muscle (a pear shaped external hip rotator that divides the greater sciatic foramen into two openings). It runs deep to the lesser (or true) pelvis, together with the bladder. As soon as the mesentery (sigmoid mesocolon) stops, the bowel is renamed the rectum (which is retroperitoneal). The lower part of the mesentery is shorter, meaning the rectum and descending colon are relatively stable. The mesentery is long in the center of the sigmoid colon, allowing it a significant range of mobility. It is intraperitoneal (unlike the rectum, ascending and descending colon, which are retroperitoneal) and is covered in mesentery, i.e. The sigmoid colon curves back on itself, and descends into the pelvis. It begins around the superior aperture of the pelvis, and is continuous with the descending colon. The S-shaped sigmoid colon is part of the hindgut and is the last region of the large bowel before the rectum. Large intestine excised with sigmoid colon highlighted Course Finally, visceral afferents relay the sensation of colonic distension. Both plexuses contain interstitial cells of Cajal, which generate the pacemaker activity of the gut essential for peristalsis. Meissner’s plexus can be found in the submucosa, while Auerbach’s myenteric plexus lies between the longitudinal and circular smooth muscle layers of the gut wall. The autonomic nervous system modulates the activity of the enteric nervous system innervating the large intestine, which includes motor and sensory neurons. Lumbar splanchnic nerves synapse in the abdominal aortic and inferior mesenteric plexuses to allow postganglionic sympathetic fibres to slow colonic motility and contract the internal anal sphincter. Most preganglionic parasympathetic neurons synapse in the wall of the hindgut, while postganglionic neurons innervate glands and muscle to increase colonic motility and to relax the internal anal sphincter. The cell bodies of the pelvic splanchnic nerves can be found in the sacral parasympathetic nucleus. The hindgut gets its blood supply from the inferior mesenteric artery, its parasympathetic nerve supply from the pelvic splanchnic nerves (S2-S4), and its sympathetic innervation from the lumbar splanchnic nerves (L1-L2). The foregut stretches from the oesophagus to the major duodenal papilla, the midgut from the major duodenal papilla to two thirds of the transverse colon, and the hindgut from this point to the pectinate line of the rectum. SSI rates were significantly increased in patients undergoing SFM.The gastrointestinal system is divided into the foregut, midgut and hindgut. This systematic review found that SFM was not associated with significantly decreased anastomotic leak rates. A subgroup analysis of rectal cancer cases found significantly higher anastomotic leak rates with SFM. SFM patients had a longer operating time and increased incisional SSI rates compared to their non-SFM counterparts. There was no significant difference in anastomotic leak rates when SFM patients were compared to their non-SFM counterparts. The overall bias risk was found to be high. Six of 74 potentially eligible studies totaling 12,398 patients (4,356 with SFM and 8,042 without SFM) were selected for further examination. The odds ratio (OR) was used for dichotomous variables, whereas the mean difference (MD) was used for continuous variables. The Mantel-Haenszel method with a random-effects model was used. Inclusion criteria were clinical studies comparing SFM to non-SFM during sigmoid and rectal resections. Anastomotic leak was the primary endpoint. PubMed, MEDLINE, EMBASE, Cochrane Library, and Scopus databases were searched by two independent researchers.

The aim of this study was to evaluate the impact of SFM on anastomotic leak and surgical site infection rates in sigmoid and rectal resections. There is no consensus regarding whether splenic flexure mobilization (SFM) should be performed selectively or routinely for sigmoid and rectal resections.

Sigmoidal flexture