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Efficacy of Pelvic Peritoneum Closure After Laparoscopic Extralevator Abdominoperineal Excision for Rectal Cancer

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Journal of Gastrointestinal Surgery Aims and scope

Abstract

Background

The descent of the small bowel into the pelvic dead space after extralevator abdominoperineal excision (ELAPE) presents a higher risk for postoperative complications. The aim of the present study was to evaluate the efficacy of pelvic peritoneum closure in preventing the small bowel from descending into the pelvic dead space and the potential consequences of this approach.

Methods

Patients with rectal cancer undergoing laparoscopic ELAPE from March 2014 to January 2019 were retrospectively investigated. Closure of the pelvic peritoneum (CPP) was routinely performed unless it was not feasible. All patients with pelvic peritoneum reconstruction were included in the CPP group, and patients without pelvic peritoneum reconstruction were included in the no-CPP group. The main outcomes included the incidences of the small bowel descending into the retro-urogenital space (space between the bladder/uterus and the sacrum on axial CT scans), perineal wound complications, perineal hernia, and small bowel obstruction (SBO).

Results

Of the 100 patients included, 79 received CPP, and 21 did not. Fewer patients with pelvic peritoneum closure had small bowels residing in the retro-urogenital space than patients without closure (17.7% vs 42.9%, p=0.014). The incidence of SBO was also lower in the CPP group (7.6% vs. 23.8%, p=0.034). Multivariable analysis showed that no-CPP (p=0.014) was an independent risk factor for the small bowel descending into the retro-urogenital space.

Conclusion

CPP may prevent the small bowel from descending into the retro-urogenital dead space in patients undergoing laparoscopic ELAPE without increasing the incidence of perineal wound complications. Prospective studies are warranted to confirm the efficacy of CPP in preventing SBO and perineal hernia.

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Data and Materials Availability

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Funding

This work was supported by the Department of Science and Technology of Sichuan Province (no. 2018RZ0091) and West China Hospital of Sichuan University (1·3·5 project of disciplines of excellence, Clinical Research Incubation Project).

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Author notes

  1. Yu Shen and Tinghan Yang contributed equally to this work and should be considered co-first authors.

Authors and Affiliations

  1. Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Guo Xue Xiang 37#, Chengdu, Sichuan Province, China

    Yu Shen, Tinghan Yang, Wenjian Meng & Ziqiang Wang

  2. Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China

    Hanjiang Zeng

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  1. Yu Shen
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Contributions

All authors contributed to the study conception and design. Material preparation and data collection and analysis were performed by Yu Shen, Tinghan Yang, and Hanjiang Zeng. The first draft of the manuscript was written by Yu Shen, and all authors commented on the subsequent versions of the manuscript. All authors read and approved the final manuscript.

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Correspondence to Wenjian Meng or Ziqiang Wang.

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Ethics Approval

This experiment was approved by the Biomedical Ethics Committee (BEC) of West China Hospital of Sichuan University (2019 No. 194).

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The authors declare no competing interests.

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Shen, Y., Yang, T., Zeng, H. et al. Efficacy of Pelvic Peritoneum Closure After Laparoscopic Extralevator Abdominoperineal Excision for Rectal Cancer. J Gastrointest Surg 25, 2668–2678 (2021). https://doi.org/10.1007/s11605-021-05046-6

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