Laparoscopic pelvic mesh placement with closure of pelvic floor entrance to prevent small intestine radiation trauma – A retrospective cohort analysis

Abstract

Laparoscopic mesh placement represents a safe and efficient procedure in patients requiring high-dose pelvic radiation, presenting with unacceptable small intestine volume in the radiation field. As an alternate to native tissue, the vicryl mesh is a safe, effective substitute for small bowel exclusion from external-beam radiation therapy.

Laparoscopic closure of the pouch of Douglas by a peritoneal running suture. A minimally invasive and prosthetic-free technique to prevent excessive dose delivery to the small bowel during pelvic irradiation for prostate cancer

“…The dayto-day transitory filling of the peritoneal cavity with nitrous oxide proposed by Cole et al has inherent limitations due to injection difficulty and instability [17]. Prosthetic material has been used to push the bowel away such as breast implants [5], saline-filled tissue expanders [6,18] and meshes [7,[19][20][21], initially implanted Fig. 2.…”

“…The use of prosthetic material has many disadvantages in comparison to the technique we described. These include a second surgery to remove the prosthesis with risk of bowel injury in an irradiated pelvis; a longer operative time and a longer length of stay with a median duration above 80 min [7,22] and a 3-5 days hospitalization for meshes; a superior cost of the procedure due to the prosthetic material; the risk of implant rupture, even if it is low [23]. Moreover, publications with animal models have warned about the risk of intraperitoneal tumor growth associated to biosynthetic meshes which was not observed with biological meshes [24,25].…”

“…This proximity can compromise the ability to deliver a curative dose despite the use of modern radiation techniques. To overcome this issue, a few surgical methods using implant of prosthetic material -such as intraabdominal prosthesis [5], tissue expanders [6] or biosynthetic meshes [7] -have been described to push the bowel away from the irradiation field.…”

Interdisciplinary consensus statement on indication and application of a hydrogel spacer for prostate radiotherapy based on experience in more than 250 patients

“…For such special situations are invasive surgical techniques available like laparoscopic mesh placement. 35 …”

Placement of pelvic mesh prior to pelvic radiotherapy using FlexDex™ – a video vignette

“…Pelvic mesh placement, to sling the bowel out from the field, can eliminate this concern and short-life biodegradable (e.g. vicryl) meshes along with a laparoscopic approach minimize any intermediate or long-term morbidity that may result from the additional surgical intervention [1,2].This strategy has now largely displaced the previous vogue for inserting a pelvic prosthesis which could prove imperfect and needs removal once therapy has been concluded [3,4].…”