The Application of Extraperitoneal Ostomy Combined with Pelvic Peritoneal Reconstruction in Laparoscopic Abdominoperineal Resection for Rectal Cancer

Background. Due to the technical difficulty, it is not common to close the pelvic peritoneum in laparoscopic abdominoperineal resection (LAPR) in China, which increases the risk of related complications. Permanent sigmoid colostomy is performed through the transperitoneal route conventionally in LAP...

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Main Authors: Sen Wang, Qingyang Meng, Jun Gao, Yuqin Huang, Jie Wang, Yang Chong, Youquan Shi, Huaicheng Zhou, Wei Wang, Dong Tang, Daorong Wang
Format: Article
Language:English
Published: Hindawi Limited 2019-01-01
Series:Gastroenterology Research and Practice
Online Access:http://dx.doi.org/10.1155/2019/3015958
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spelling doaj-26970e9a42084972820baf64f543c9262020-11-24T20:45:15ZengHindawi LimitedGastroenterology Research and Practice1687-61211687-630X2019-01-01201910.1155/2019/30159583015958The Application of Extraperitoneal Ostomy Combined with Pelvic Peritoneal Reconstruction in Laparoscopic Abdominoperineal Resection for Rectal CancerSen Wang0Qingyang Meng1Jun Gao2Yuqin Huang3Jie Wang4Yang Chong5Youquan Shi6Huaicheng Zhou7Wei Wang8Dong Tang9Daorong Wang10The First Clinical Medical College of Nanjing Medical University, Nanjing, Jiangsu 210029, ChinaDepartment of General Surgery, General Surgery Institute of Yangzhou, Northern Jiangsu Province Hospital, Clinical Medical College, Yangzhou University, Yangzhou, Jiangsu 225000, ChinaDepartment of General Surgery, General Surgery Institute of Yangzhou, Northern Jiangsu Province Hospital, Clinical Medical College, Yangzhou University, Yangzhou, Jiangsu 225000, ChinaDalian Medical University, Dalian, Liaoning 116044, ChinaDalian Medical University, Dalian, Liaoning 116044, ChinaDepartment of General Surgery, General Surgery Institute of Yangzhou, Northern Jiangsu Province Hospital, Clinical Medical College, Yangzhou University, Yangzhou, Jiangsu 225000, ChinaDepartment of General Surgery, General Surgery Institute of Yangzhou, Northern Jiangsu Province Hospital, Clinical Medical College, Yangzhou University, Yangzhou, Jiangsu 225000, ChinaDepartment of General Surgery, General Surgery Institute of Yangzhou, Northern Jiangsu Province Hospital, Clinical Medical College, Yangzhou University, Yangzhou, Jiangsu 225000, ChinaDepartment of General Surgery, General Surgery Institute of Yangzhou, Northern Jiangsu Province Hospital, Clinical Medical College, Yangzhou University, Yangzhou, Jiangsu 225000, ChinaDepartment of General Surgery, General Surgery Institute of Yangzhou, Northern Jiangsu Province Hospital, Clinical Medical College, Yangzhou University, Yangzhou, Jiangsu 225000, ChinaDepartment of General Surgery, General Surgery Institute of Yangzhou, Northern Jiangsu Province Hospital, Clinical Medical College, Yangzhou University, Yangzhou, Jiangsu 225000, ChinaBackground. Due to the technical difficulty, it is not common to close the pelvic peritoneum in laparoscopic abdominoperineal resection (LAPR) in China, which increases the risk of related complications. Permanent sigmoid colostomy is performed through the transperitoneal route conventionally in LAPR. This leads to the high occurrence of parastomal hernias and bowel obstructions. To prevent the complications and reduce surgical costs of LAPR, we performed some modifications for it. Methods. 38 patients diagnosed with low rectal cancer during July 2014 to July 2016 received LAPR with our modifications. First, the mobilization of the rectum and lymphadenectomy were identical to the classical routine method. Second, two sutures were performed on the pelvic peritoneum with the first to reduce the tension, followed by the second continuous suture to close the pelvic floor. Third, a tunnel was made between the parietal peritoneum and abdominal wall for the end sigmoid to pass through to finish the colostomy. Results. LAPR was performed on totally 38 patients successfully with no case transferring to open surgery. The follow-up period was from 1 month to 1 year. The mean operative time was 142.2 ± 16.5 min ranging from 100 min to 175 min. The mean hospital stay was 12.0 ± 1.5 days. No case underwent the reconstruction of stoma. There was not a single complication of LAPR with these two techniques that occurred to all 38 patients. Conclusion. We consider LAPR with our two techniques feasible and safe, which can be accepted quickly to improve the life quality of patients. Therefore, we suggest our procedures as the first choice during LAPR surgery. This trial is registered with trial registration number 2014028.http://dx.doi.org/10.1155/2019/3015958
collection DOAJ
language English
format Article
sources DOAJ
author Sen Wang
Qingyang Meng
Jun Gao
Yuqin Huang
Jie Wang
Yang Chong
Youquan Shi
Huaicheng Zhou
Wei Wang
Dong Tang
Daorong Wang
spellingShingle Sen Wang
Qingyang Meng
Jun Gao
Yuqin Huang
Jie Wang
Yang Chong
Youquan Shi
Huaicheng Zhou
Wei Wang
Dong Tang
Daorong Wang
The Application of Extraperitoneal Ostomy Combined with Pelvic Peritoneal Reconstruction in Laparoscopic Abdominoperineal Resection for Rectal Cancer
Gastroenterology Research and Practice
author_facet Sen Wang
Qingyang Meng
Jun Gao
Yuqin Huang
Jie Wang
Yang Chong
Youquan Shi
Huaicheng Zhou
Wei Wang
Dong Tang
Daorong Wang
author_sort Sen Wang
title The Application of Extraperitoneal Ostomy Combined with Pelvic Peritoneal Reconstruction in Laparoscopic Abdominoperineal Resection for Rectal Cancer
title_short The Application of Extraperitoneal Ostomy Combined with Pelvic Peritoneal Reconstruction in Laparoscopic Abdominoperineal Resection for Rectal Cancer
title_full The Application of Extraperitoneal Ostomy Combined with Pelvic Peritoneal Reconstruction in Laparoscopic Abdominoperineal Resection for Rectal Cancer
title_fullStr The Application of Extraperitoneal Ostomy Combined with Pelvic Peritoneal Reconstruction in Laparoscopic Abdominoperineal Resection for Rectal Cancer
title_full_unstemmed The Application of Extraperitoneal Ostomy Combined with Pelvic Peritoneal Reconstruction in Laparoscopic Abdominoperineal Resection for Rectal Cancer
title_sort application of extraperitoneal ostomy combined with pelvic peritoneal reconstruction in laparoscopic abdominoperineal resection for rectal cancer
publisher Hindawi Limited
series Gastroenterology Research and Practice
issn 1687-6121
1687-630X
publishDate 2019-01-01
description Background. Due to the technical difficulty, it is not common to close the pelvic peritoneum in laparoscopic abdominoperineal resection (LAPR) in China, which increases the risk of related complications. Permanent sigmoid colostomy is performed through the transperitoneal route conventionally in LAPR. This leads to the high occurrence of parastomal hernias and bowel obstructions. To prevent the complications and reduce surgical costs of LAPR, we performed some modifications for it. Methods. 38 patients diagnosed with low rectal cancer during July 2014 to July 2016 received LAPR with our modifications. First, the mobilization of the rectum and lymphadenectomy were identical to the classical routine method. Second, two sutures were performed on the pelvic peritoneum with the first to reduce the tension, followed by the second continuous suture to close the pelvic floor. Third, a tunnel was made between the parietal peritoneum and abdominal wall for the end sigmoid to pass through to finish the colostomy. Results. LAPR was performed on totally 38 patients successfully with no case transferring to open surgery. The follow-up period was from 1 month to 1 year. The mean operative time was 142.2 ± 16.5 min ranging from 100 min to 175 min. The mean hospital stay was 12.0 ± 1.5 days. No case underwent the reconstruction of stoma. There was not a single complication of LAPR with these two techniques that occurred to all 38 patients. Conclusion. We consider LAPR with our two techniques feasible and safe, which can be accepted quickly to improve the life quality of patients. Therefore, we suggest our procedures as the first choice during LAPR surgery. This trial is registered with trial registration number 2014028.
url http://dx.doi.org/10.1155/2019/3015958
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