Application of modified primary closure of the pelvic floor in laparoscopic extralevator abdominal perineal excision for low rectal cancer

Wang, Yanlei; Zhang, Xiang; Mao, Jiajia; Zhang, Wenqiang; Dong, Huijuan; Zhang, Fan-Pei; Dong, Shuohui; Zhang, Wenjie; Dai, Yong

doi:10.3748/wjg.v24.i30.3440

Cited by 12 publications

(4 citation statements)

References 24 publications

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“…At present, whether the pelvic peritoneum should be closed after laparoscopic Miles' surgery in low rectal cancer is still debatable [7][8][9] . The present study cannot prove the association between pelvic peritoneum reconstruction and the occurrence of postoperative intestinal obstruction.…”

Section: Discussionmentioning

confidence: 99%

Application of Pelvic Peritoneum Closure Combined with Extraperitoneal Colostomy in Laparoscopic Surgery for Low Rectal Cancer

Yao

Liu

Sun

et al. 2023

PAR

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Background: In the treatment of colorectal cancer, laparoscopic surgery has seen a significant amount of success. Reducing the risk of postoperative complications and improving patients’ quality of life can be accomplished by appropriately employing pelvic peritoneal repair and sigmoid colostomy when appropriate. Objective: To compare fusion closure of pelvic peritoneum combined with extraperitoneal colostomy with non-closure of pelvic peritoneum combined with intraperitoneal colostomy in patients with low rectal cancer who had permanent colostomy. Methods: Low rectal cancer patients admitted to Hengshui People’s Hospital for permanent colostomy were evaluated. The participants were divided into two groups: an observation and a control group. All 30 cases in the observation group underwent pelvic peritoneum closure and extraperitoneal colostomy, while the other 30 cases in the control group underwent intraperitoneal colostomy. The C-reactive protein (CRP) levels of the participants in both groups were evaluated for 6 months to 2 years (24 h before, 24 h after, 48 h after, 96 h after surgery). Results: Comparing the colostomy operative time, time to first passage of flatus postoperatively, time to first defecation postoperatively, length of hospital stay, laboratory indicators, stoma-related complications, colostomy function, etc., the colostomy operative time significantly differed between the two groups (P < 0.05); the observation group did considerably better than the control group in terms of stoma-related complications and bowel movement control 6 months after surgery (P < 0.05); and although serum CRP levels increased in both groups 48 h after surgery, the difference was significant (P < 0.05). Conclusion: Extraperitoneal colostomy can improve the quality of life of patients with permanent stoma and reduce the occurrence of stoma-related complications. Thus, this technique is worthy of promotion in clinical practice.

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Section: Discussionmentioning

confidence: 99%

Application of Pelvic Peritoneum Closure Combined with Extraperitoneal Colostomy in Laparoscopic Surgery for Low Rectal Cancer

Yao

Liu

Sun

et al. 2023

PAR

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“…Improper pelvic oor peritoneal sutures may lead to residual suture space, improving the risk of postoperative internal hernia. Wang [17] reconstructs the pelvic oor peritoneum with a Hem-o-lok clip,however, it still has the risk of intestinal obstruction due to the small intestine herniation. The brosis of pelvic oor tissue after neoadjuvant radiotherapy and chemotherapy was prominent [6].…”

Section: Discussionmentioning

confidence: 99%

Short-Term Outcomes of Pelvic Peritoneum Reconstruction with Barbed Suture After Laparoscopic Rectal Resection for Rectal Cancer

Wen

Shen

Huang

et al. 2021

Preprint

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Background: Laparoscopic rectal resection may cause various surgical complications including perineal hernia and adhesive small-bowel obstruction. Pelvic peritoneum reconstruction (PPR) could prevent those complications. The aim of the study is to evaluate the short-term clinical, technical and safety outcomes of PPR using the barbed suture in laparoscopic rectal resection. Methods: This is a retrospective cohort study conducted in Chengdu second’s people hospital. Between January 2014 and December 2019, a total of 402 patients who underwent curative surgery for rectal cancer in Chengdu Second People’s Hospital were enrolled in the study. Among them, 216 patients who underwent laparoscopic rectal resection with PPR were allocated into the experimental group, and 186 patients who underwent laparoscopic rectal resection without PPR were allocated into control group. All the patients received standard preoperative and postoperative treatments. Observational indicators (1) surgical and postoperative conditions; (2) postoperative pathological examination. (3) postoperative complications. The data were represented by X ± s. t-test and X2 test were used for counting data. Results (1) Surgery condition: all patients in the two groups underwent successful surgery without conversion to open surgery. There were no differences between the two groups in terms of surgical approach, resection margin, tumor size, postoperative T-stage, postoperative N-stage, positive lymph nodes, harvest lymph nodes, perineal wound infection, perineal hernia, postoperative pneumonia, postoperative hemorrhage, presacral fluid, or abscess. The operative time, blood loss, the incidence of anastomotic leakage, and small-bowel obstruction showed a significant difference between the two groups. Conclusion We hypothesized that pelvic peritoneum reconstruction with barbed suture could improve the efficiency of intracorporeal closure of the pelvic cavity after in laparoscopic rectal resection, which can significantly reduce postoperative perineal-related complications. Further, we expect that use of the barbed sutures will reduce intra-operative stress on the endoscopic surgeon.

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“…Improper pelvic oor peritoneal sutures may lead to residual suture space, improving the risk of postoperative internal hernia. Wang [15] reconstructs the pelvic oor peritoneum with a Hem-o-lok clip; however, it still has the risk of intestinal obstruction due to the small intestine herniation. The results showed no signi cant difference between the patients in PPR group and non-PPR group, but the obstruction of the PPR group was signi cantly lower than non-PPR group.…”

Section: Discussionmentioning

confidence: 99%

The Impact of Complications on Short-Term Outcomes of Pelvic Peritoneum Reconstruction with Barbed Suture in Laparoscopic Rectal Resection for Rectal Cancer

Wen

Shen

Huang

et al. 2021

Preprint

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Objective: This study aimed to evaluate the safety and short-term outcomes of pelvic peritoneum reconstruction with barbed sutures in laparoscopic rectal resection for rectal cancer. Methods: This is a retrospective cohort study conducted in Chengdu second’s people hospital. The clinicopathological data of 402 patients with rectal cancer admitted to our department hospital from January to December 2019 were collected. There was total of 402 patients, including 218 males and 174 females, with an average age of 68 years. Among them, 216 patients who underwent laparoscopic rectal resection with pelvic peritoneum reconstruction (PPR) were allocated into the PPR group, and 186 patients who underwent conventional laparoscopic rectal resection were allocated into a non-PPR group. All the patients received standard preoperative and postoperative treatments. Observational indicators (1) surgical and postoperative conditions; (2) postoperative pathological examination. (3) postoperative complications. Results (1) Surgery condition: all patients in the two groups underwent successful surgery without conversion to open surgery. There were no differences between the two groups in terms of surgical approach, resection margin, tumor size, postoperative T-stage, postoperative N-stage, positive lymph nodes, harvest lymph nodes, perineal wound infection, perineal hernia, postoperative pneumonia, postoperative hemorrhage, presacral fluid, or abscess. The operative time, blood loss, the incidence of anastomotic leakage, and small-bowel obstruction showed a significant difference between the two groups. Conclusion pelvic peritoneum reconstruction with barbed suture in laparoscopic rectal resection is safe and feasible for the treatment of rectal cancer, which can significantly reduce postoperative perineal-related complications.

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Application of modified primary closure of the pelvic floor in laparoscopic extralevator abdominal perineal excision for low rectal cancer

Cited by 12 publications

References 24 publications

Application of Pelvic Peritoneum Closure Combined with Extraperitoneal Colostomy in Laparoscopic Surgery for Low Rectal Cancer

Application of Pelvic Peritoneum Closure Combined with Extraperitoneal Colostomy in Laparoscopic Surgery for Low Rectal Cancer

Short-Term Outcomes of Pelvic Peritoneum Reconstruction with Barbed Suture After Laparoscopic Rectal Resection for Rectal Cancer

The Impact of Complications on Short-Term Outcomes of Pelvic Peritoneum Reconstruction with Barbed Suture in Laparoscopic Rectal Resection for Rectal Cancer

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