Prevention of complications following pelvic exenteration with the use of mammary implants in the pelvic cavity: Technique and results of 28 cases

Valle, Mario; Federici, Orietta; Ialongo, Pasquale; Graziano, F; Garofalo, Alfredo

doi:10.1002/jso.21716

Cited by 21 publications

(13 citation statements)

References 9 publications

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“…Different methods of pelvic floor reconstruction have been proposed in order to avoid these complications, but there is no consensus on which is the best technique . The use of breast implants to prevent bowel loops from occupying the space has seldom been described .…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2019

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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.

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Section: Introductionmentioning

confidence: 99%

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

et al. 2019

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“…This occurs in up to 15% of patients following exenteration and confers a mortality close to 50% . Some have proposed the use of mammary implants to fill the pelvis but there is concern regarding prosthesis infection . Polypropylene meshes were used in our earlier cases but concerns regarding infection, mesh erosion and a permanent indwelling foreign body have seen their use decrease.…”

Section: Discussionmentioning

confidence: 99%

Addressing the empty pelvic syndrome following total pelvic exenteration: does mesh reconstruction help?

et al. 2019

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Aim Perineal wound complications and pelvic abscesses remain a major source of morbidity after total pelvic exenteration. The void created in the pelvis after these multi‐visceral resections leads to fluid accumulation and translocation of bowel within the pelvic cavity, which may increase the risk of pelvic abscess, perineal fluid discharge with perineal wound dehiscence and prolonged ileus. This study describes a novel technique using degradable synthetic mesh with overlying omentum to preclude small bowel and fill the empty space after total pelvic exenteration, and aimed to investigate the rate of pelvic abscess and perineal wound‐related complications in this group. Method Ten patients who underwent total pelvic exenteration followed by implantation of degradable synthetic mesh at a quaternary referral centre were identified and included. The mesh was moulded to the contours of the bony pelvis at the level of the pubic symphysis anteriorly and inferior to the sacral promontory posteriorly. The data on the number of postoperative perineal wound‐related complications including pelvic abscesses were collected. Results There was no perioperative mortality. Five patients (50%) developed postoperative complications. One patient developed an abscess inferior to the mesh that required surgical drainage and another had a pre‐sacral collection that was successfully managed conservatively. Two patients developed intra‐abdominal collections requiring percutaneous drainage. Median length of stay was 20 days (range 16–35). No perineal hernia or entero‐perineal fistula was detected in any patient either clinically or radiologically at a median follow‐up of 7 months. Conclusion Degradable synthetic mesh reconstruction following exenterative surgery may reduce postoperative complications related to the perineal wound.

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“…This may be of clinical relevance. A study by Valle et al placed a mammary implant in the pelvic cavity after exenteration of locally advanced rectal, cervical or bladder cancers [14]. All 28 patients were treated with adjuvant radiotherapy and had no evidence of radiation enteritis.…”

Section: Discussionmentioning

confidence: 99%

Acute toxicity after a diverting stoma and spacer prior to chemoradiation in locally advanced rectal cancer

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Ceha

Niehe

et al. 2015

Radiotherapy and Oncology

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Prevention of complications following pelvic exenteration with the use of mammary implants in the pelvic cavity: Technique and results of 28 cases

Abstract: We retain the encouraging results observed that the use of mammary implants in the pelvic cavity after pelvic exenteration should be part of the cultural patrimony of the surgeon who approaches this type of major radical surgery.

Cited by 21 publications

References 9 publications

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

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

Addressing the empty pelvic syndrome following total pelvic exenteration: does mesh reconstruction help?

Acute toxicity after a diverting stoma and spacer prior to chemoradiation in locally advanced rectal cancer

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