Spiliotis-Farfarelos Maneuver for the Management of Small Bowel Obstruction and Frozen Pelvis in Patients With Peritoneal Metastasis

Abstract

The management of the advanced peritoneal disease is demanding especially in cases of extensive bowel infiltration and the obstruction of the gastrointestinal tract in different sites. Patients with bowel obstruction due to peritoneal carcinomatosis have an overall survival that ranges from three to eight months to four to five weeks based on the operability or not of the disease, respectively. The decision to operate should carefully consider the balance between the probability of symptomatic relief and the risk of severe perioperative complications and survival after surgery. The extent of the disease and postoperative malnutrition could further complicate patients' postoperative course. We aim to present an operative maneuver of bowel preparation and fixation in cases of extensive infiltration of the small bowel by peritoneal carcinomatosis (PC) in order to eliminate the risk of postoperative fistula formation or anastomotic leakage.

Consensus Guideline for the Management of Malignant Gastrointestinal Obstruction in Patients with Peritoneal Surface Malignancies

“…33–36,38,39,41,42 Average overall survival was 3-11 months for surgical correction studies, 33–36,39–42 and ranged from 11 to 26 months for debulking studies, suggesting a highly selected cohort in the latter. 35,38,43…”

“…Of 1822 abstracts screened, 243 were included for full text review, and 25 studies reporting outcomes specific to patients with peritoneal metastases were included for data extraction and quality assessment. Of these, 12 studies focused on surgical palliation, [33][34][35][36][37][38][39][40][41][42][43][44] seven studies focused on percutaneous upper GI decompression (PGID), [7][8][9][45][46][47][48] and three studies each focused on upper GI and colorectal stenting. 17,18,23,[49][50][51] These studies are summarized in Tables 3-5 and elaborated upon in recommendations for blocks 2, 4 and 5.…”

“…In our review encompassing 12 studies on surgical palliation for MGIO in patients with peritoneal carcinomatosis, eight studies addressed surgical correction, three focused on tumor debulking alongside surgical correction, and one addressed acute abdominal emergencies as detailed in Block 2 (Tables 3 and 5). [33][34][35][36][37][38][39][40][41][42][43][44] Technical success was defined as the ability to perform surgical correction, with rates ranging from 77.6% to 100%. 33,36,39 One study reported 100% technical success, however six patients with non-therapeutic laparotomy were excluded, suggesting an anticipated technical success rate below 100%.…”

“…33,35,[37][38][39]42,44 Reobstruction rates varied from 3.3% to 47.5%, [33][34][35]38,39,41 with postoperative complication rates between 17.3% and 50.0%. [33][34][35][36][38][39][40][41][42][43] Major complications, graded Clavien Dindo 3-4 equivalent, occurred in 0% to 24.8% of cases and were attributed mainly to intra-abdominal or cardiopulmonary sequelae such as collections requiring drainage, sepsis, bleeding, myocardial infarction, pulmonary embolism, and respiratory distress. [33][34][35][36]38,39,41,42 Average overall survival was 3-11 months for surgical correction studies, [33][34][35][36][39][40][41][42] and ranged from 11 to 26 months for debulking studies, suggesting a highly selected cohort in the latter.…”

“…[33][34][35][36]38,39,41,42 Average overall survival was 3-11 months for surgical correction studies, [33][34][35][36][39][40][41][42] and ranged from 11 to 26 months for debulking studies, suggesting a highly selected cohort in the latter. 35,38,43 The least invasive surgical approach should be pursued for obstructive relief. Bypass or stoma creation may be considered if resection/anastomosis is precluded by the extent or location of obstructions, mesenteric foreshortening, or concern for short gut.…”