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Efficacy of Pelvic Peritoneum Closure After Laparoscopic Extralevator Abdominoperineal Excision for Rectal Cancer
Journal of Gastrointestinal Surgery ( IF 3.2 ) Pub Date : 2021-07-09 , DOI: 10.1007/s11605-021-05046-6
Yu Shen 1 , Tinghan Yang 1 , Hanjiang Zeng 2 , Wenjian Meng 1 , Ziqiang Wang 1
Affiliation  

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.



中文翻译:

腹腔镜提肌外提肌会阴切除术治疗直肠癌后盆腔腹膜闭合术的疗效

背景

提肌外腹会阴切除术 (ELAPE) 后小肠下降到盆腔死腔中,术后并发症的风险更高。本研究的目的是评估盆腔腹膜闭合术在防止小肠下降到盆腔死腔方面的功效以及这种方法的潜在后果。

方法

回顾性研究了2014年3月至2019年1月接受腹腔镜ELAPE的直肠癌患者。除非不可行,否则常规进行盆腔腹膜闭合 (CPP)。所有盆腔腹膜重建患者均纳入CPP组,未进行盆腔腹膜重建的患者纳入非CPP组。主要结果包括小肠下降到泌尿生殖道后间隙(轴向 CT 扫描中膀胱/子宫和骶骨之间的空间)、会阴伤口并发症、会阴疝和小肠梗阻 (SBO) 的发生率。

结果

在包括的 100 名患者中,79 名接受了 CPP,21 名未接受。盆腔腹膜闭合的患者小肠位于泌尿生殖道后间隙的患者少于未闭合的患者(17.7% vs 42.9%,p = 0.014)。CPP 组的 SBO 发生率也较低(7.6% 对 23.8%,p = 0.034)。多变量分析表明,无 CPP ( p = 0.014) 是小肠下行至泌尿生殖道后间隙的独立危险因素。

结论

在接受腹腔镜 ELAPE 的患者中,CPP 可以防止小肠下降到泌尿生殖道后死腔,而不会增加会阴伤口并发症的发生率。有必要进行前瞻性研究来证实 CPP 在预防 SBO 和会阴疝方面的功效。

更新日期:2021-07-12
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