A Novel Technique With Ileal Mesentery to Reconstruct the Pelvic Peritoneum After Pelvic Dissection With End Colostomy for Rectal Cancer

Abstract

See video on DCR YouTube Channel at https:// youtu.be/lvF_lE7sROA BACKGROUND: 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. IMPACT OF INNOVATION: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.PRELIMINARY RESULTS: 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. CONCLUSIONS AND FUTURE DIRECTIONS: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.

Author Reply To the Editor

“…Meanwhile, if the peritoneum at the anterior wall of the pelvis was partly sufficient, we sutured the peritoneum first to reduce the size of the defect. 1 In a word, these differences support the novelty of our technique.…”

“…We appreciate the invitation to reply to a comment on our article published in Diseases of the Colon & Rectum (DCR), 1 giving us the chance to discuss our technique in more detail and clarify the questions raised by Dionysios Voros. We thus read for the first time Prof Dionysios Voros’ article 2 published in DCR in 1996.…”

Letter to the Editor

“…To the Editor—The article published in your recent issue by Luo et al 1 is not a novel technique. I have published the first 10 cases of this technique in your journal previously.…”