CT assessment of the quality of omentoplasty and its implications for perineal wound healing

Abstract

Purpose This study was designed to examine the impact of an omentoplasty and its quality on pelviperineal morbidity after abdominoperineal resection (APR) for rectal cancer. Methods This was a retrospective single-centre study of consecutive patients undergoing APR for primary or recurrent rectal cancer between 2000 and 2018. Quality of omentoplasty was categorised (sufficient vs insufficient) based on postoperative CT scans. Main study endpoints were perineal wound healing and perineal hernia. Results This study included 100 patients: 16 with a sufficient omentoplasty, 16 with an insufficient omentoplasty, and 68 without omentoplasty. Rate of pelviperineal complications within 30 days was 44%, 69% and 64% (P = 0.283), and delayed wound healing at 3 months was 19%, 54% and 27%, respectively (P = 0.109). Sufficient omentoplasty was not significantly associated with less delayed healing in multivariable analysis (OR 0.597; 95% CI 0.149-2.397). An insufficient omentoplasty demonstrated significantly higher rates of delayed healing at 6 months (46% vs 14%; P = 0.016) and chronic perineal sinus at 12 months (31% vs 3%; P = 0.008) compared with no omentoplasty. Conclusion This relatively small series suggest that even a sufficient omentoplasty, as determined by postoperative imaging, does not reduce pelviperineal morbidity after APR for rectal cancer. The methodology of CT-based assessment of an omentoplasty as well as the correlation with postoperative outcomes has to be validated in future studies.

A comparative multicentre study evaluating gluteal turnover flap for wound closure after abdominoperineal resection for rectal cancer

“…It is promising that there were no perineal hernias after gluteal turnover flap closure, despite the larger number of hysterectomies in this group which increases the risk of perineal hernia [ 13 ]. The dermis, which is stitched to the contralateral levator remnant, might serve as pelvic floor reconstruction and might therefore lower the risk of perineal hernia after APR.…”

Quantifying displacement of urogenital organs after abdominoperineal resection for rectal cancer

“…Patients who underwent APR for primary or recurrent rectal cancer were selected from three existing databases between 2001 and 2018 [ 5 , 7 , 8 ]. Inclusion was based on available sagittal pelvic imaging prior to APR and between 6 and 18 months postoperatively.…”

“…In the other two existing cohort studies, postoperative imaging was performed as part of routine daily practice. The need for informed consent was waived for these retrospective studies [ 5 , 8 ].…”

Management of Perineal Wounds Following Pelvic Surgery

“…In certain circumstances, due to its mobility and weight, an omental pedicle could even place undue pressure to the superficial layers of the perineum on standing and, unlike other abdominal structures such as bowel that are often limited in descent by mesenteric length, predispose to hernia. 39…”

“…Furthermore, there is the observation that an inadequate omental pedicle following APR, as assessed in a novel study using postoperative cross-sectional imaging, correlates with impaired wound healing. 39 Another consideration is that the soft, compliant nature of an omental pedicle fills predominantly the pelvic space, and may provide little or no support for the more caudal anal defect itself or structural integrity to the neopelvic floor. In certain circumstances, due to its mobility and weight, an omental pedicle could even place undue pressure to the superficial layers of the perineum on standing and, unlike other abdominal structures such as bowel that are often limited in descent by mesenteric length, predispose to hernia.…”