Yu Shen1, Tinghan Yang1, Hanjiang Zeng2, Wenjian Meng3, Ziqiang Wang4. 1. Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Guo Xue Xiang 37#, Chengdu, Sichuan Province, China. 2. Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China. 3. Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Guo Xue Xiang 37#, Chengdu, Sichuan Province, China. mengwenjian@126.com. 4. Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Guo Xue Xiang 37#, Chengdu, Sichuan Province, China. wangziqiang@scu.edu.cn.
Abstract
BACKGROUND: The descent of the small bowel into the pelvic dead space after extralevator abdominoperineal excision (ELAPE) presents a higher risk for postoperative complications. The aim of the present study was to evaluate the efficacy of pelvic peritoneum closure in preventing the small bowel from descending into the pelvic dead space and the potential consequences of this approach. METHODS: Patients with rectal cancer undergoing laparoscopic ELAPE from March 2014 to January 2019 were retrospectively investigated. Closure of the pelvic peritoneum (CPP) was routinely performed unless it was not feasible. All patients with pelvic peritoneum reconstruction were included in the CPP group, and patients without pelvic peritoneum reconstruction were included in the no-CPP group. The main outcomes included the incidences of the small bowel descending into the retro-urogenital space (space between the bladder/uterus and the sacrum on axial CT scans), perineal wound complications, perineal hernia, and small bowel obstruction (SBO). RESULTS: Of the 100 patients included, 79 received CPP, and 21 did not. Fewer patients with pelvic peritoneum closure had small bowels residing in the retro-urogenital space than patients without closure (17.7% vs 42.9%, p=0.014). The incidence of SBO was also lower in the CPP group (7.6% vs. 23.8%, p=0.034). Multivariable analysis showed that no-CPP (p=0.014) was an independent risk factor for the small bowel descending into the retro-urogenital space. CONCLUSION: CPP may prevent the small bowel from descending into the retro-urogenital dead space in patients undergoing laparoscopic ELAPE without increasing the incidence of perineal wound complications. Prospective studies are warranted to confirm the efficacy of CPP in preventing SBO and perineal hernia.
BACKGROUND: The descent of the small bowel into the pelvic dead space after extralevator abdominoperineal excision (ELAPE) presents a higher risk for postoperative complications. The aim of the present study was to evaluate the efficacy of pelvic peritoneum closure in preventing the small bowel from descending into the pelvic dead space and the potential consequences of this approach. METHODS:Patients with rectal cancer undergoing laparoscopic ELAPE from March 2014 to January 2019 were retrospectively investigated. Closure of the pelvic peritoneum (CPP) was routinely performed unless it was not feasible. All patients with pelvic peritoneum reconstruction were included in the CPP group, and patients without pelvic peritoneum reconstruction were included in the no-CPP group. The main outcomes included the incidences of the small bowel descending into the retro-urogenital space (space between the bladder/uterus and the sacrum on axial CT scans), perineal wound complications, perineal hernia, and small bowel obstruction (SBO). RESULTS: Of the 100 patients included, 79 received CPP, and 21 did not. Fewer patients with pelvic peritoneum closure had small bowels residing in the retro-urogenital space than patients without closure (17.7% vs 42.9%, p=0.014). The incidence of SBO was also lower in the CPP group (7.6% vs. 23.8%, p=0.034). Multivariable analysis showed that no-CPP (p=0.014) was an independent risk factor for the small bowel descending into the retro-urogenital space. CONCLUSION:CPP may prevent the small bowel from descending into the retro-urogenital dead space in patients undergoing laparoscopic ELAPE without increasing the incidence of perineal wound complications. Prospective studies are warranted to confirm the efficacy of CPP in preventing SBO and perineal hernia.
Authors: C Moreno-Sanz; M Manzanera-Díaz; F J Cortina-Oliva; J de Pedro-Conal; M Clerveus; J Picazo-Yeste Journal: Tech Coloproctol Date: 2011-09-29 Impact factor: 3.781
Authors: Gijsbert D Musters; Charlotte E L Klaver; Robbert J I Bosker; Jacobus W A Burger; Peter van Duijvendijk; Boudewijn van Etten; Anna A W van Geloven; Eelco J R de Graaf; Christiaan Hoff; Jeroen W A Leijtens; Harm J T Rutten; Baljit Singh; Ronald J C L M Vuylsteke; Johannes H W de Wilt; Marcel G W Dijkgraaf; Willem A Bemelman; Pieter J Tanis Journal: Ann Surg Date: 2017-06 Impact factor: 12.969
Authors: P W Thomas; J E M Blackwell; P J J Herrod; O Peacock; R Singh; J P Williams; N G Hurst; W J Speake; A Bhalla; J N Lund Journal: Tech Coloproctol Date: 2019-08-07 Impact factor: 3.781