BACKGROUND: Pelvic peritoneal surfaces are often denuded extensively during radical pelvic operations, providing raw areas for small bowel adherence and potential obstruction. This hazard is compounded in patients who receive whole pelvic adjuvant irradiation. Omental and synthetic slings or redundant sigmoid colon have been incompletely effective in excluding small bowel from the pelvic area. Furthermore, these exclusion procedures have been associated with significant complications. STUDY DESIGN: Anterior parietal peritoneal flaps were created in ten patients who were undergoing radical hysterectomy and pelvic lymphadenectomy for Stage Ib carcinoma of the cervix. These flaps were sewn to the posterior parietal peritoneum at the pelvic brim or higher and functioned as bowel slings. RESULTS: Small bowel loops were effectively excluded from the pelvic area as documented by oral contrast radiologic evaluation at two weeks and six months, postoperatively. Six patients received adjuvant whole pelvic irradiation. There have been no small bowel complications or obstructions during a follow-up period of six to 28 months (median of 16 months). CONCLUSIONS: This pilot series suggests that a parietal peritoneal sling can be performed safely and may protect the small bowel from complications as a result of adhesion formation or radiation.
BACKGROUND: Pelvic peritoneal surfaces are often denuded extensively during radical pelvic operations, providing raw areas for small bowel adherence and potential obstruction. This hazard is compounded in patients who receive whole pelvic adjuvant irradiation. Omental and synthetic slings or redundant sigmoid colon have been incompletely effective in excluding small bowel from the pelvic area. Furthermore, these exclusion procedures have been associated with significant complications. STUDY DESIGN: Anterior parietal peritoneal flaps were created in ten patients who were undergoing radical hysterectomy and pelvic lymphadenectomy for Stage Ib carcinoma of the cervix. These flaps were sewn to the posterior parietal peritoneum at the pelvic brim or higher and functioned as bowel slings. RESULTS: Small bowel loops were effectively excluded from the pelvic area as documented by oral contrast radiologic evaluation at two weeks and six months, postoperatively. Six patients received adjuvant whole pelvic irradiation. There have been no small bowel complications or obstructions during a follow-up period of six to 28 months (median of 16 months). CONCLUSIONS: This pilot series suggests that a parietal peritoneal sling can be performed safely and may protect the small bowel from complications as a result of adhesion formation or radiation.
Authors: Hunter C Gits; Eric J Dozois; Matthew T Houdek; Thanh P Ho; Scott H Okuno; Rachael M Guenzel; Laura A McGrath; Alan J Kraling; Jedediah E Johnson; Scott C Lester Journal: Adv Radiat Oncol Date: 2022-06-28