Single port-assisted fully laparoscopic abdominoperineal resection (APR) with immediate V-RAM flap reconstruction of the perineal defect

Omentoplasty to assist perineal defect closure following laparoscopic abdominoperineal resection

AIM

This technical note describes laparoscopic production of a well vascularized, omental flap of adequate size to fill the pelvic floor defect in the course of laparoscopic abdominoperineal resection (LAPR).

METHOD

The omentum is laparoscopically mobilized and transposed to the pelvis following full LAPR in three discrete stages.

RESULTS

Laparoscopic omental mobilization, transfer and buttressing of a primary perineal repair reduces pelvic dead space and facilitates closure following LAPR with minimal additional operative time or complications and a potential reduction in perineal wound associated morbidity.

CONCLUSION

Laparoscopic omental mobilization is technically feasible and provides a safe method to aid perineal wound closure.

Omental pedicle flaps following proctectomy: a systematic review

AIM

Abdominoperineal excision (APR) for cancer carries significant morbidity of the perineal wound. An omental pedicle graft has been used to fill the pelvis and limit attendant complications after radical extirpation of the anorectum. A review of the literature was conducted to determine whether omentoplasty following APR reduces perineal wound complications.

METHOD

Three major databases (PubMed, MEDLINE and the Cochrane Library) were searched. The review included original articles reporting outcomes after APR and omentoplasty from January 1950 to July 2012.

RESULTS

Fourteen studies involving 891 patients (mean age 61 years, 59.8% men) were included. Median follow-up was 13.5 months. A variety of omentoplasty techniques added a median of 20 min to the operating time. The mean rate of primary wound healing was 66.8%, time to wound healing 24 days and weighted mean wound infection rate 14.4% with omentoplasty compared with 50.1%, 79 days and 18.5% in patients having no omentoplasty.

CONCLUSION

Omental mobilization, transfer and buttressing of primary perineal repair following proctectomy reduces perineal wound morbidity with minimal additional operating time or flap-associated morbidity.