Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, China.
Department of Gastrointestinal Surgery, Suining Central Hospital, Suining, China.
Dis Colon Rectum. 2022 Sep 1;65(9):e910-e913. doi: 10.1097/DCR.0000000000002490. Epub 2022 May 25.
After abdominoperineal resection, low anterior resection, and end colostomy for lower rectal cancer, it is necessary to reconstruct the pelvic peritoneum to avoid small bowel obstruction, perineal hernia, and radiation enteritis in patients for whom postoperative radiotherapy is planned. However, pelvic peritoneal closure is technically difficult in patients who lack enough peritoneum to cover the defect or have received neoadjuvant radiation and have a rigid pelvis.
The impact of this innovation is to reconstruct the pelvic peritoneum with the distal ileal mesentery laparoscopically.
TECHNOLOGY, MATERIALS AND METHODS: After removal of the tumor, the distal ileal mesentery was selected to completely cover the defect. Subsequently, suturing of the ileal mesentery to the posterior wall of the urinary bladder and all sides of the pelvic cavity was performed. Finally, the patients were returned to the headfirst supine position to ensure that there was no small bowel falling into the pelvic dead space.
All surgical procedures were successfully performed laparoscopically from January 2019 to April 2021. No perineal complications or intestinal obstructions occurred during the follow-up period.
This novel technique was found to be safe and effective. Moreover, it provided an economical method for the reconstruction of the pelvic peritoneum using autologous material, which could preserve the small intestine in the abdomen to avoid related complications. Additional larger series of patients with longer follow-up are needed to validate the safety and feasibility of this method.
低位直肠癌行腹会阴联合切除术、低位前切除术和末端结肠造口术后，对于计划行术后放疗的患者，需要重建盆腔腹膜，以避免小肠梗阻、会阴疝和放射性肠炎。然而，对于缺乏足够腹膜覆盖缺损或接受新辅助放疗且骨盆僵硬的患者，盆腔腹膜关闭在技术上具有挑战性。
本创新的影响是通过腹腔镜用回肠系膜远端重建盆腔腹膜。
技术、材料和方法：在切除肿瘤后，选择回肠系膜以完全覆盖缺损。随后，对回肠系膜与膀胱后壁和盆腔所有侧面进行缝合。最后，将患者恢复到头高脚低位仰卧位，以确保没有小肠落入盆腔死腔。
从 2019 年 1 月至 2021 年 4 月，所有手术均成功地通过腹腔镜完成。在随访期间，未发生会阴并发症或肠梗阻。
该新技术被发现是安全有效的。此外，它使用自体材料为盆腔腹膜重建提供了一种经济有效的方法，可以将小肠保留在腹部，避免相关并发症。需要更大系列、更长随访时间的患者来验证该方法的安全性和可行性。
