A study on the clinical application of greater omental pedicle flap transplantation to correct anterior resection syndrome in patients with low rectal cancer

Qin, Haiquan; Lv, Meng; Huang, Zijing; Liao, Jiankun; Yan, Feng; Luo, Shanshan; Lai, Hao; Tang, Weizhong; Mo, Xianwei

doi:10.1016/j.reth.2021.05.003

Cited by 6 publications

(7 citation statements)

References 35 publications

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“…So far, our centre has conducted a cohort study on TME combined with pedicled greater omentum flap transplantation and the postoperative anal defaecatory function of the cohort has been evaluated. We have found that LARS has been greatly relieved, and all the results and feedback are encouraging [4,5]. In our method, total mesenteric reconstruction (TMR) with a greater omentum flap is simple to perform, does not increase the operating time or difficulty and plays a significant role in preventing We conclude that on the premise of preserving the anus as much as possible, transplantation of pedicled greater omentum flap into the posterior rectal space can significantly improve postoperative LARS.…”

Section: Total Mesorectal Excision Plus Total Intersphincteric Resect...mentioning

confidence: 68%

Total mesorectal excision plus total intersphincteric resection combined with pedicled omentum flap transplantation – A video vignette

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Section: Total Mesorectal Excision Plus Total Intersphincteric Resect...mentioning

confidence: 68%

Total mesorectal excision plus total intersphincteric resection combined with pedicled omentum flap transplantation – A video vignette

et al. 2022

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“…This leads to decreased dilation and poor compliance of the new rectum; even a tiny amount of faeces can cause increased intestinal pressure and frequent occurrence of stools [ 28 ]. A previous study found that by using pedicled omental transposition to fill the pelvic floor, reconstruct the presacral structure, increase the intestinal buffer force, and improve compliance of the new rectum, patients have better postoperative stool control function than a control group [ 12 ]. In addition, pedicled omental transposition is a simple and easy method with a short operative time.…”

Section: Discussionmentioning

confidence: 99%

“…In the study of anterior resection syndrome conducted by Dr. Qin [ 12 ], the pedicled greater omentum was transposed to the anterior sacral area and filled behind the newly constructed rectum, significantly improving postoperative anterior resection syndrome in patients with low rectal cancer. Indeed, the patients had good postoperative anal defecation and defecation control functions which brought new revelation to us.…”

Section: Introductionmentioning

confidence: 99%

Advantages of total proctocolectomy with straight ileoanal anastomosis plus pedicled omental transposition for familial adenomatous polyposis: a preliminary study

et al. 2022

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Purpose To achieve excellent postoperative bowel function in familial adenomatous polyposis (FAP) patients, it is important to reconstruct the digestive tract. The aim of this study is to preliminarily discuss the advantages of total proctocolectomy with straight ileoanal anastomosis (TPC-SIAA) plus pedicled omental transposition for FAP. Methods A retrospective study was carried out in two hospitals analysing data for FAP patients who underwent surgical treatments between 2015 and 2021. Perioperative outcomes and early and mid-term anal functions were analysed. Results After excluding 4 patients who underwent total proctocolectomy with permanent ileostomy, 10 patients were enrolled in the study. Among the 10 patients, 3 received TPC-SIAA plus pedicled omental transposition, 3 received total proctocolectomy with ileal pouch-anal anastomosis (TPC-IPAA), and 4 received total colectomy with ileal pouch-rectal anastomosis (TC-IPRA). Except for one case conversion to laparotomy, laparoscopic surgery was performed for the other cases. The incidence of early postoperative complications was apparently higher with pouch anastomosis (57.1%) than straight anastomosis (0%). Frequencies of bowel movement and low anterior resection syndrome (LARS) score were higher for TPC-SIAA than the other two surgical procedures in the early term; over time, however, the frequencies of bowel movement and LARS score both showed a decreasing trend. In addition, combined with anorectal pressure detection and magnetic resonance imaging defecography at the 3rd month after TPC-SIAA plus pedicled omental transposition, defecation coordination was good. The dynamics and receptivity of the new rectum tended to be as expected. Conclusion Although the three surgical procedures are safe and feasible surgical options for FAP, TPC-SIAA plus pedicled omental transposition is more consistent with intestinal physiology, with good intestinal compliance, and anal function tended to be as expected over time. Nevertheless, more extensive studies are needed to confirm these benefits.

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“…In the past, our center tried to transplant pedicled greater omentum to the rear of the neo-rectum after TME in patients with middle and low rectal cancer, and the postoperative follow-up found that the defecation function of these patients was better, which provided us with inspiration for improving postoperative LARS 21 . This suggests that we should pay attention to the physiological differences between the dilatation characteristics of sigmoid colon or descending colon used to construct the neorectum and the original rectum, and pay attention to the in uence of changes in volume, pressure 41 , compliance 42,43 and movement of the neo-rectum on postoperative anorectal function.…”

Section: Discussionmentioning

confidence: 99%

“…There is no standard and effective prevention and treatment of LARS after surgery. In our center, the pedicled greater omentum was applied in the reconstruction of the sacral fascia after total mesorectal excision (TME) in patients with middle and low rectal cancer, and it was observed that the anorectal function of these patients recovered faster and better, with satisfactory results 21 . This inspired us to pay attention to the difference between the expansion characteristics of sigmoid colon or descending colon used to construct the neo-rectum and the physiological characteristics of the original rectum, and to the in uence of the changes in the volume, compliance, pressure and movement of the new rectum on postoperative anorectal function, which may be an important reason for the occurrence of LARS.…”

Section: Introductionmentioning

confidence: 99%

Mesorectal reconstruction with pedicled greater omental transplantation to relieve low anterior resection syndrome following total intersphincteric resection in patients with ultra-low rectal cancer

Liao

Qin

Wang

et al. 2022

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BACKGROUND AND OBJECTIVES: Total intersphincteric resection (ISR) is the ultimate anus-preserving surgery for patients with ultra-low rectal cancer (ULRC), which can result in various degrees of anorectal dysfunction. Known as low anterior resection syndrome (LARS), it seriously affects the postoperative quality of life of patients. The aim of this study was to discuss the value of mesorectal reconstruction with pedicled greater omental transplantation (PGOT) to relieve LARS following total ISR in patients with ULRC, hoping to provide new ideas and strategies for the prevention and improvement of LARS. METHODS We retrospectively analyzed hospitalization data and postoperative anorectal function of 26 ULRC patients, who were met inclusion and exclusion criteria in our center from January 2015 to February 2022. And combined with the results of anorectal manometry and rectal magnetic resonance imaging (MRI) defecography of some patients, we assessed comprehensively anorectal physiological and morphological changes of the patients after surgery, and their correlation with LARS. RESULTS In this study, 26 patients with ULRC were enrolled and divided into observation group (n = 15) and control group (n = 11) according to whether pedicled omental transplantation was performed. There were no significant differences in surgical results such as operative time, intraoperative blood loss and postoperative complications between the two groups (P > 0.05). Postoperative follow-up showed that patients in both groups showed severe LARS within 3 months after surgery, but from the 3rd month after surgery, LARS in both groups gradually began to decrease, especially in the observation group, which showed faster recovery and better recovery, with statistically significant differences (P < 0.001). Through anorectal manometry, the mean rectal resting pressure in the observation group was significantly lower than that in the control group (P = 0.010). In addition, the postoperative thickness of the posterior rectal mesenterium in the observation group was significantly higher than that in the control group (P = 0.001), and also higher than the preoperative level (P = 0.018). Moreover, rectal MRI defecography showed that the new rectum had good compliance under the matting of greater omentum, and its intestinal peristalsis was coordinated. CONCLUSION ULRC patients, with the help of greater omentum, coordinated their neo-rectum peristalsis after total ISR and recovery of LARS was faster and better. PGOT is expected to be an effective strategy for LARS prevention and treatment of ULRC patients after surgery and is worthy of clinical promotion.

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A study on the clinical application of greater omental pedicle flap transplantation to correct anterior resection syndrome in patients with low rectal cancer

Cited by 6 publications

References 35 publications

Total mesorectal excision plus total intersphincteric resection combined with pedicled omentum flap transplantation – A video vignette

Total mesorectal excision plus total intersphincteric resection combined with pedicled omentum flap transplantation – A video vignette

Advantages of total proctocolectomy with straight ileoanal anastomosis plus pedicled omental transposition for familial adenomatous polyposis: a preliminary study

Mesorectal reconstruction with pedicled greater omental transplantation to relieve low anterior resection syndrome following total intersphincteric resection in patients with ultra-low rectal cancer

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