Empty pelvis syndrome: the use of breast prosthesis in the prevention of complications

Abstract

Aim Empty pelvis syndrome and radiation‐induced bowel injury are two major clinical issues resulting from the pelvic dead space after pelvic exenteration (PE). In order to avoid these complications, different methods of pelvic floor reconstruction have been proposed. We report our experience on the use of breast prosthesis. Method Fifty‐three patients who underwent PE and three who underwent palliative surgery with silicone breast prosthesis placement were included. Results Forty‐seven posterior PE, six total PE and three palliative procedures were identified. Sphincter preservation was feasible in 34 patients (62.3%). There were no deaths. Overall morbidity was 37.5%. There were no complications such as sepsis or obstruction related to the prosthesis. Adjuvant radiotherapy was delivered in 16 cases (30.1%) without any side‐effects. Reconstruction of intestinal continuity was possible in 12 patients (36.3%) with sphincter preservation and the prosthesis allowed a prompt identification of the rectal stump. Conclusion Breast prosthesis placement is a simple and safe method to minimize complications resulting from empty pelvis syndrome and can be adopted to exclude bowel loops from the radiation field. Reconstruction of intestinal continuity after resection is also simplified.

Novel use of the Bakri balloon to minimize empty pelvis syndrome following laparoscopic total pelvic exenteration

“…However, it is associated with donor site morbidity, is not feasible via a laparoscopic approach and still fails to keep the small bowel out of the pelvis. Mesh interposition [8] and placement of a silicone breast prosthesis [13] in the pelvic cavity have been tried but these involve the permanent placement of foreign body material, are costly and are associated with long term risks of displacement and migration.…”

“…The Bakri balloon, though initially designed to control postpartum haemorrhage [18], met these specifications. The 500 ml capacity of the balloon is sufficient to occupy the residual cavity which may vary from 125 to 380 ml [13].…”

“…The procedure leaves a large empty space in the pelvis, often leading to postoperative collections, abscess formation, prolonged ileus, intestinal obstruction and small bowel fistulas, collectively termed empty pelvis syndrome (EPS) [2][3][4]. A number of surgical options [5][6][7][8][9][10][11][12][13] have been suggested to overcome this problem. However, to date, the search for the ideal solution continues.…”

Empty pelvis syndrome: a systematic review of reconstruction techniques and their associated complications

“…Only 11.6% (10/86) of patients underwent TPE. Two studies [13,18] opted for the use of silicone breast prothesis with the other using saline-filled prothesis [27] (Table 2). The technique for the silicone prosthesis was similar: first measuring the volume of the empty pelvis with saline and then matching this to the prosthesis.…”

“…Reports include reduced long-term incidence of perineal hernia [11]; however, in the BioPEX randomized controlled trial (RCT) [12] the use of biological mesh in extralevator abdominoperineal resection (APR) was not found to reduce the rates of surgical and nonsurgical complications compared with primary closure. The use of other pelvic fillers remains controversial, showing efficacy in case reports and small cohorts only [13,14].…”