ArticleTechniques in coloproctology2024
Pelvic inlet closure with bladder peritoneal flap reduces postoperative ileus after abdominoperineal resection.
Article in Techniques in coloproctology, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.
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1 citing paper in PubMed.
- Laparoscopic Peritoneal Flap Closure for Internal Hernia Associated with Colostomy: Two Case Reports.Surgical case reports · 2026Article
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7 authors.
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Abstract
backgroundAbdominoperineal resection (APR) is the standard treatment for locally advanced distal rectal cancer (LADRC) following neoadjuvant treatment when sphincter-preserving procedures are inapplicable. However, complications such as perineal site infection, perineal hernia and postoperative ileus remain ongoing challenges. We aimed to compare the rate of postoperative ileus due to pelvic incarceration in APR patients with/without pelvic inlet closure.
methodsLADRC patients, who underwent APR with/without pelvic inlet closure between January 2016 and September 2022 at a comprehensive cancer center were analyzed retrospectively. After laparoscopic APR, the pelvic inlet was closed with a bladder peritoneal flap. A U-shaped peritoneal flap, up to approximately 15 × 20 cm in size, was peeled off from the dome of the bladder with its base at the posterosuperior part of the bladder.
resultsOf the 80 patients included in the analysis, 27 (34%) underwent laparoscopic APR with pelvic inlet closure and 53 (66%) had no pelvic inlet closure. There was no significant difference in age, mean body mass index and American Society of Anesthesiologists score among both groups. Patients with a pelvic inlet closure had a significantly lower postoperative ileus rate because of incarceration [0 vs. 17%, n = 9/53; (P = 0.03)] and a shorter hospital stay [6.74 ± 4.21 vs. 9.00 ± 5.99 days; P = 0.03]. The rate of perineal surgical site infection (SSI) [5/27 (18.5%) vs. 14/53 (26.4%); P = 0.61) was lower in the laparoscopic APR with pelvic inlet closure group, but this was not significant.
conclusionPelvic inlet closure using a bladder peritoneal flap following APR is a safe and feasible procedure associated with reduced postoperative ileus due to pelvic incarceration rates, emergent surgical interventions due to pelvic incarceration and shorter hospital stay.
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