Abstract
Pelvic infection is a significant clinical problem after pelvic exenteration. The clinical benefit of an omental flap in reducing the incidence of such infections is unknown. The aim of this study was to evaluate whether an omental flap after pelvic exenteration reduces the incidence of pelvic infection and the length of postoperative hospital stay. In this study, we demonstrate a safe, effective, simple method for reducing the incidence of pelvic infection using an omental flap. We performed pelvic exenteration for tumors that were suspected to have extensive invasion to the bladder, prostate, or uterus. The omentum was dissected from the transverse colon and greater curvature of the stomach. The flap was based on the right gastroepiploic vessels and tunneled in the retrocolic plane, through the mesentery of the transverse colon and ileocecum, to the defect. Twenty-seven patients were analyzed retrospectively. Ten patients received omental flaps, and 17 patients underwent pelvic exenteration without an omental flap. The incidence of pelvic infection was significantly reduced in the patients with omental flaps.
This is a preview of subscription content, log in via an institution to check access.
References
Brunschwig A. Complete excision of pelvic viscera for advanced carcinoma; a one-stage abdominoperineal operation with end colostomy and bilateral ureteral implantation into the colon above the colostomy. Cancer. 1948;1:177–83.
Wiig JN, Poulsen JP, Larsen S, Braendengen M, Waehre H, Giercksky KE. Total pelvic exenteration with preoperative irradiation for advanced primary and recurrent rectal cancer. Eur J Surg. 2002;168:42–8.
Jimenez RE, Shoup M, Cohen AM, Paty PB, Guillem J, Wong WD. Contemporary outcomes of total pelvic exenteration in the treatment of colorectal cancer. Dis Colon Rectum. 2003;46:1619–25.
Moriya Y, Akasu T, Fujita S, Yamamoto S. Total pelvic exenteration with distal sacrectomy for fixed recurrent rectal cancer in the pelvis. Dis Colon Rectum. 2004;47:2047–53 discussion 2053.
Ishiguro S, Akasu T, Fujita S, Yamamoto S, Kusters M, Moriya Y. Pelvic exenteration for clinical T4 rectal cancer: oncologic outcome in 93 patients at a single institution over a 30-year period. Surgery. 2009;145:189–95.
Rahbari NN, Ulrich AB, Bruckner T, et al. Surgery for locally recurrent rectal cancer in the era of total mesorectal excision: is there still a chance for cure? Ann Surg. 2011;253:522–33.
Wydra D, Emerich J, Sawicki S, Ciach K, Marciniak A. Major complications following exenteration in cases of pelvic malignancy: a 10-year experience. World J Gastroenterol. 2006;12:1115–9.
Moreaux J, Horiot A, Barrat F, Mabille J. Obliteration of the pelvic space with pedicled omentum after excision of the rectum for cancer. Am J Surg. 1984;148:640–4.
Hultman CS, Sherrill MA, Halvorson EG, et al. Utility of the omentum in pelvic floor reconstruction following resection of anorectal malignancy: patient selection, technical caveats, and clinical outcomes. Ann Plast Surg. 2010;64:559–62.
Nilsson PJ. Omentoplasty in abdominoperineal resection: a review of the literature using a systematic approach. Dis Colon Rectum. 2006;49:1354–61.
Anderin C, Martling A, Lagergren J, Ljung A, Holm T. Short-term outcome after gluteus maximus myocutaneous flap reconstruction of the pelvic floor following extra-levator abdominoperineal excision of the rectum. Colorectal Dis. 2012;14:1060–4.
Holm T, Ljung A, Haggmark T, Jurell G, Lagergren J. Extended abdominoperineal resection with gluteus maximus flap reconstruction of the pelvic floor for rectal cancer. Br J Surg. 2007;94:232–8.
Nisar PJ, Scott HJ. Myocutaneous flap reconstruction of the pelvis after abdominoperineal excision. Colorectal Dis. 2009;11:806–16.
Patsner B. Closed-suction drainage versus no drainage following radical abdominal hysterectomy with pelvic lymphadenectomy for stage IB cervical cancer. Gynecol Oncol. 1995;57:232–4.
Doherty NS, Griffiths RJ, Hakkinen JP, Scampoli DN, Milici AJ. Post-capillary venules in the “milky spots” of the greater omentum are the major site of plasma protein and leukocyte extravasation in rodent models of peritonitis. Inflamm Res. 1995;44:169–77.
Fukatsu K, Saito H, Han I, et al. The greater omentum is the primary site of neutrophil exudation in peritonitis. J Am Coll Surg. 1996;183:450–6.
Goldsmith HS, Griffith AL, Kupferman A, Catsimpoolas N. Lipid angiogenic factor from omentum. JAMA. 1984;252:2034–6.
Yamamoto T, Mylonakis E, Keighley MR. Omentoplasty for persistent perineal sinus after proctectomy for Crohn’s disease. Am J Surg. 2001;181:265–7.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors declare no conflicts of interest in association with the present study.
Rights and permissions
About this article
Cite this article
Miyamoto, Y., Akiyama, T., Sakamoto, Y. et al. Omental flap after pelvic exenteration for pelvic cancer. Surg Today 46, 1471–1475 (2016). https://doi.org/10.1007/s00595-016-1348-y
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00595-016-1348-y