Use of omental pedicle grafts in abdominoperineal resection

Abstract

Following abdominoperineal resection, the empty space of the pelvic hollow is filled by loops of small intestine, which may become fixed and cause obstruction. In patients who require adjuvant radiotherapy, such loops of intestine fixed in the pelvis may predispose the patient to radiation enteritis. Proposed methods to prevent such fixed loops of small intestine in the pelvis include closure of the pelvic peritoneum with subperitoneal drainage, fixation of the bladder to the sacrum, retroversion of the uterus, placement of prosthetic mesh, and placement of an omental pedicle graft in the pelvic hollow. The omental pedicle graft has the advantages of ease of performance, use of autologous tissue, and filling the pelvic hollow with vascularized tissue, which should decrease the risk of postoperative pelvic abscess. This study reviews the technique of omental pedicle graft closure of the pelvis and the results of it in our initial eight patients. The omental pedicle graft has become the preferred method of pelvic reconstruction following abdominoperineal resection at Grady Memorial Hospital, Atlanta, Georgia.