Clinical Significance of Pelvic Peritonization in Laparoscopic Dixon Surgery

Abstract

Background:Pelvic floor peritoneum reconstruction is a key step in various standard resections for open radical rectal cancer. However, during endoscopic surgery, most surgeons do not close the pelvic floor peritoneum. This study aims to evaluate the efficacy of pelvic peritonization during laparoscopic Dixon surgery using an observational study.Methods:A total of 189 patients, who underwent laparoscopic Dixon surgery at Tianjin Union Medical Center, China, were analyzed retrospectively. All of the cases were divided into two groups according to the differences of surgical procedure. The 92 patients in Group A (observation group) underwent pelvic peritonization and the 97 patients in Group B (control group) did not undergo this procedure. Postoperative complications were observed in the two groups, compared, and analyzed using the Chi-square or Fisher's exact test.Results:The incidence of anastomotic leakage was significantly lower in Group A than in Group B (P = 0.014). A significant difference was found in the postoperative short-term (P = 0.029) and long-term (P = 0.029) ileus rates between the two groups, with Group A exhibiting a lower rate than Group B. Patients in Group A had significantly lower rates of postoperative infections than those in Group B (χ2 = 7.606, P = 0.006; χ2 = 4.464, P = 0.035). Patients in Group A had significantly lower rates of deep venous thrombosis than those in Group B (χ2 = 8.531, P = 0.003).Conclusions:Pelvic peritonization effectively reduces postoperative complications, such as anastomotic leakage, which warrants its increased use in laparoscopic surgery.

Short‐term outcomes of pelvic floor peritoneum closure in endoscopic low anterior resection of rectal cancer: A propensity score matching analysis

“…Few studies have reported the outcome of PC during LAR of rectal cancer; most surgeons believe that it did not change long‐ or short‐term outcomes. However, while a recent study reported that PC in Dixon surgery reduced the occurrence of AL and adhesive intestinal obstruction 9 ; therefore, the outcomes of PC need further study.…”

“…Pelvic floor peritoneum closure (PC) is a key step in various standard resections for open radical rectal cancer surgery. 9 However, PC in endoscopic LAR is not routine and remains controversial, partly due to the technical difficulties and time required for suturing. Few studies have reported the outcome of PC during LAR of rectal cancer; most surgeons believe that it did not change long-or short-term outcomes.…”

Risk factors for colorectal anastomotic leakage and preventive measures: a retrospective cohort study

“…Напротив, установлено, что укрепление швов колоректального аппаратного анастомоза имело статистическую достоверность в повышении риска НА (ОР 2,352; 95 % ДИ 1,112-5,00; p = 0,027). Однако при многофакторном анализе уже не было показано [38]. Авторы отмечали статистически значимое снижение НА в группе пациентов, которым тазовая брюшина была восстановлена (p = 0,014).…”

Colorectal anastomosis in rectal cancer surgery: methods of anastomotic leakage prevention

“…с участием 584 пациентов, говорящие о том, что частота развития НА достоверно сопоставима в группах с ушиванием и без ушивания тазовой брюшины, но частота повторных операций по поводу НА в группе пациентов с ушиванием тазовой брюшины достоверно ниже (36,4 % против 11,1 %; р = 0,025) [55]. Еще одно китайское исследование с участием 189 пациентов показало, что ушивание тазовой брюшины не только снижает риск повторных операций, но и уменьшает частоту развития НА (р = 0,14) [56].…”