Closure of Pelvic Floor Entrance With Autogenous Peritoneum Flipping

Closure of Pelvic Floor Entrance With Autogenous Peritoneum Flipping | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Short Report Closure of Pelvic Floor Entrance With Autogenous Peritoneum Flipping wang-ping zhang, xinyi zhou, jian-guang sun, jun li This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4284988/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract At present, people are paying more and more attention to whether pelvic peritoneum should be closed after rectal cancer surgery [1-2]. Pelvic floor closure during surgery can not only protect abdominal organs and presacral wounds, but also help to control infection, limit inflammation, and reduce the occurrence of postoperative complications such as adhesive intestinal obstruction [3]. The accompanying video reports a novel surgical method to close the pelvic floor by turning over the autologous peritoneal wall during the operation, with good postoperative recovery. The advantages of this surgery are low cost, convenient sampling, rapid repair, and reduced risk of infection [4]. It is a simple, safe, economical, minimally invasive, and highly feasible surgical method, which can achieve good patient recovery. Figures Figure 1 Figure 2 Figure 3 Full Text At present, people are paying more and more attention to whether pelvic peritoneum should be closed after rectal cancer surgery [ 1 – 2 ]. Pelvic floor closure during surgery can not only protect abdominal organs and presacral wounds, but also help to control infection, limit inflammation, and reduce the occurrence of postoperative complications such as adhesive intestinal obstruction [ 3 ]. The accompanying video reports a novel surgical method to close the pelvic floor by turning over the autologous peritoneal wall during the operation, with good postoperative recovery. The advantages of this surgery are low cost, convenient sampling, rapid repair, and reduced risk of infection [ 4 ]. It is a simple, safe, economical, minimally invasive, and highly feasible surgical method, which can achieve good patient recovery. Here, we present a video of a man who was admitted 2 years after sigmoid colorectal cancer surgery for a recurrence of the pelvic floor in the past year. The patient was found to have anastomotic recurrence and pelvic metastasis after rectal cancer surgery, and the disease progressed and continued to defecate. This video shows the closure of the pelvic entrance after resection of recurrent pelvic cancer with peritoneal inversion. First, the patient is placed in the supine position, lithotomy position, with both hips slightly flexed, abduction 45°, knee slightly flexed, head down and foot up 30 °, slightly right leaning. During the operation, it was found that the recurrent tumor invaded the pelvic blood vessels and the lateral abdominal wall, and R0 resection could not be performed. The descending colon was dehiscised at a distance of 10cm from the recurrent tumor with the proximal ultrasonic scalpel. During the operation, the recurrent intestinal segment at the rectal anastomosis and the recurrent pelvic cancer were resected with R1, and the resection range was up to the level of pelvic floor muscle. Considering the poor effect of systemic chemotherapy for recurrent rectal cancer, pelvic salvage radiotherapy was required if pelvic recurrence occurred again. In order to avoid the potential risk of radiation enteritis caused by the small intestine falling into the empty pelvic cavity, the pelvic entrance was closed during the operation. In this video, autologous parietal peritoneum was turned over after repair to close the pelvic entrance. First, the length and short diameter of the patient's pelvic entrance were measured with No. 4 silk thread, and based on the length and short diameter data, an appropriate size of peritoneum was marked on the right lateral wall of the pelvis, and the incision margin was marked with an electric knife. After that, the margin peritoneum was lifted and carefully peeled off from the pelvic wall using an electric knife. The thickness of the peritoneum was paid attention to, and a little adipose tissue was preferred. According to the cut margin, the three edges of the peritoneum were carefully cut, the peritoneum was turned over to completely cover the pelvic entrance, and 3 − 0 absorbable thread was intermittently sutured at the left pelvic wall, posterior peritoneum, and posterior bladder wall in front, and the needle distance was maintained about 1cm to fix the peritoneum, so as to achieve the effect of completely sealing the pelvic entrance (Fig. 3 ). Results and follow-up: The patient was given anti-infective treatment and nutritional support after operation. On the third day after operation, the patient's intestinal function recovered and the feces were discharged from the stoma. The postoperative recovery was satisfactory, and autologous peritoneal turnover had the same advantages as biological mesh in preventing small bowel from falling into the pelvis (Fig. 2 ), with lower cost, convenient sampling, rapid repair, and reduced risk of infection. There was no special postoperative recovery. During the follow-up of more than 3 months, no tumor recurrence or postoperative complications such as intestinal obstruction were found. Declarations Supplementary Information: The online version of the Supplementary Information contains supplementary material and is available at https: //doi.org/10.1007/ s10151 -021-02425- 8 Author contributions : Li Jun contributed to the surgical design, discussion and case analysis. Zhang Wangping contributed to surgical operations and paper writing. Zhou Xinyi, Xie Haiting and Sun Jianguang contributed to case analysis and provided technical support for paper writing. All authors have read and acknowledged the final version of the article. Data availability: The datasets used and/or analyzed during the current study are available from the corresponding author upon reasonable request. Acknowledgements: Not applicable. Competing interests: The author declares that there is no conflict of interest. Ethical approval: All cases were in accordance with the procedures approved by the Ethics Committee of the Second Affiliated Hospital of Zhejiang University School of Medicine (Approval No.: (2023) Lunxiyan; (1121)). 2023.1121). Patient consent: Patient consent has been obtained And agree to publish. References Lai Xu, Yu Zhaoshi, Tang Jun, et al. The significance of closing pelvic floor peritoneum in laparoscopic Miles radical operation for rectal cancer [J]. Advances in Modern Biomedicine, 2015, 15(20) : 3895-3897. Liu Yi, Tang Liming, Qian Jun, et al. The significance of closing pelvic floor peritoneum in laparoscopic assisted Miles surgery for rectal cancer [J]. Journal of Practical Clinical Medicine, 2012,16 (17) : 87-89. Shen Y，Yang T，Zeng H，et al. Efficacy of pelvic peritoneum closure after laparoscopic extralevator abdominoperineal excision for rectal cancer［J］. J Gastrointest Surg，2021，25（10）：2668⁃2678. Meng Zhu, Wang Han, He Muye et al. Research progress of mesothelial cells and their role in peritoneal adhesion [J]. Chinese Journal of Pharmacology, 2019,35(12):1398-1405. (in Chinese) DOI:10.16153/ J.1002-7777.2021.12.011. Additional Declarations No competing interests reported. Supplementary Files file.mp4 Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4284988","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Short Report","associatedPublications":[],"authors":[{"id":292674551,"identity":"30d060a0-4f1a-424d-99f7-bec6f7bb6693","order_by":0,"name":"wang-ping zhang","email":"","orcid":"","institution":"Haiyan People’s Hospital","correspondingAuthor":false,"prefix":"","firstName":"wang-ping","middleName":"","lastName":"zhang","suffix":""},{"id":292674552,"identity":"0bcc575a-a029-45de-a5bb-21abcbcbaa66","order_by":1,"name":"xinyi zhou","email":"","orcid":"","institution":"the Second Affiliated Hospital of Zhejiang University School of 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mesh).\u003c/p\u003e","description":"","filename":"1.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-4284988/v1/917a29fabe8df1063699fbf0.jpeg"},{"id":55381025,"identity":"24adfb17-ccfa-4934-9428-6cc1c07f0e72","added_by":"auto","created_at":"2024-04-26 13:49:15","extension":"jpeg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":186147,"visible":true,"origin":"","legend":"\u003cp\u003eCT image of autologous peritoneum flipping (arrow indicates the peritoneum).\u003c/p\u003e","description":"","filename":"2.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-4284988/v1/52e599e43133d24bcaf976f1.jpeg"},{"id":55382093,"identity":"c423dc99-216b-457c-9213-8195efa99370","added_by":"auto","created_at":"2024-04-26 13:57:15","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":699673,"visible":true,"origin":"","legend":"\u003cp\u003eSurgical effect of pelvic floor closure using autologous 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Pelvic floor closure during surgery can not only protect abdominal organs and presacral wounds, but also help to control infection, limit inflammation, and reduce the occurrence of postoperative complications such as adhesive intestinal obstruction [\u003cspan class=\"CitationRef\"\u003e3\u003c/span\u003e]. The accompanying video reports a novel surgical method to close the pelvic floor by turning over the autologous peritoneal wall during the operation, with good postoperative recovery. The advantages of this surgery are low cost, convenient sampling, rapid repair, and reduced risk of infection [\u003cspan class=\"CitationRef\"\u003e4\u003c/span\u003e]. It is a simple, safe, economical, minimally invasive, and highly feasible surgical method, which can achieve good patient recovery.\u003c/p\u003e\n\u003cp\u003eHere, we present a video of a man who was admitted 2 years after sigmoid colorectal cancer surgery for a recurrence of the pelvic floor in the past year. The patient was found to have anastomotic recurrence and pelvic metastasis after rectal cancer surgery, and the disease progressed and continued to defecate. This video shows the closure of the pelvic entrance after resection of recurrent pelvic cancer with peritoneal inversion. First, the patient is placed in the supine position, lithotomy position, with both hips slightly flexed, abduction 45\u0026deg;, knee slightly flexed, head down and foot up 30 \u0026deg;, slightly right leaning. During the operation, it was found that the recurrent tumor invaded the pelvic blood vessels and the lateral abdominal wall, and R0 resection could not be performed. The descending colon was dehiscised at a distance of 10cm from the recurrent tumor with the proximal ultrasonic scalpel. During the operation, the recurrent intestinal segment at the rectal anastomosis and the recurrent pelvic cancer were resected with R1, and the resection range was up to the level of pelvic floor muscle. Considering the poor effect of systemic chemotherapy for recurrent rectal cancer, pelvic salvage radiotherapy was required if pelvic recurrence occurred again. In order to avoid the potential risk of radiation enteritis caused by the small intestine falling into the empty pelvic cavity, the pelvic entrance was closed during the operation. In this video, autologous parietal peritoneum was turned over after repair to close the pelvic entrance. First, the length and short diameter of the patient's pelvic entrance were measured with No. 4 silk thread, and based on the length and short diameter data, an appropriate size of peritoneum was marked on the right lateral wall of the pelvis, and the incision margin was marked with an electric knife. After that, the margin peritoneum was lifted and carefully peeled off from the pelvic wall using an electric knife. The thickness of the peritoneum was paid attention to, and a little adipose tissue was preferred. According to the cut margin, the three edges of the peritoneum were carefully cut, the peritoneum was turned over to completely cover the pelvic entrance, and 3\u0026thinsp;\u0026minus;\u0026thinsp;0 absorbable thread was intermittently sutured at the left pelvic wall, posterior peritoneum, and posterior bladder wall in front, and the needle distance was maintained about 1cm to fix the peritoneum, so as to achieve the effect of completely sealing the pelvic entrance (Fig.\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e\n\u003cp\u003eResults and follow-up: The patient was given anti-infective treatment and nutritional support after operation. On the third day after operation, the patient's intestinal function recovered and the feces were discharged from the stoma. The postoperative recovery was satisfactory, and autologous peritoneal turnover had the same advantages as biological mesh in preventing small bowel from falling into the pelvis (Fig.\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e), with lower cost, convenient sampling, rapid repair, and reduced risk of infection.\u003c/p\u003e\n\u003cp\u003eThere was no special postoperative recovery. During the follow-up of more than 3 months, no tumor recurrence or postoperative complications such as intestinal obstruction were found.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eSupplementary Information: \u003c/strong\u003eThe online version of the Supplementary Information contains supplementary material and is available at https: //doi.org/10.1007/ s10151 -021-02425- 8\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor contributions\u003c/strong\u003e: Li Jun contributed to the surgical design, discussion and case analysis. Zhang Wangping contributed to surgical operations and paper writing. Zhou Xinyi, Xie Haiting and Sun Jianguang contributed to case analysis and provided technical support for paper writing. All authors have read and acknowledged the final version of the article.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability:\u0026nbsp;\u003c/strong\u003eThe datasets used and/or analyzed during the current study are available from the corresponding author upon reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements:\u0026nbsp;\u003c/strong\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests:\u003c/strong\u003e The author declares that there is no conflict of interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical approval:\u0026nbsp;\u003c/strong\u003eAll cases were in accordance with the procedures approved by the Ethics Committee of the Second Affiliated Hospital of Zhejiang University School of Medicine (Approval No.: (2023) Lunxiyan; (1121)). 2023.1121).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePatient consent:\u0026nbsp;\u003c/strong\u003ePatient consent has been obtained And agree to publish.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eLai Xu, Yu Zhaoshi, Tang Jun, et al. The significance of closing pelvic floor peritoneum in laparoscopic Miles radical operation for rectal cancer [J]. Advances in Modern Biomedicine, 2015, 15(20) : 3895-3897.\u003c/li\u003e\n \u003cli\u003eLiu Yi, Tang Liming, Qian Jun, et al. The significance of closing pelvic floor peritoneum in laparoscopic assisted Miles surgery for rectal cancer [J]. Journal of Practical Clinical Medicine, 2012,16 (17) : 87-89.\u003c/li\u003e\n \u003cli\u003eShen Y，Yang T，Zeng H，et al. Efficacy of pelvic peritoneum closure after laparoscopic extralevator abdominoperineal excision for rectal cancer［J］. J Gastrointest Surg，2021，25（10）：2668⁃2678.\u003c/li\u003e\n \u003cli\u003eMeng Zhu, Wang Han, He Muye et al. Research progress of mesothelial cells and their role in peritoneal adhesion [J]. Chinese Journal of Pharmacology, 2019,35(12):1398-1405. (in Chinese) DOI:10.16153/ J.1002-7777.2021.12.011.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"","lastPublishedDoi":"10.21203/rs.3.rs-4284988/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4284988/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"At present, people are paying more and more attention to whether pelvic peritoneum should be closed after rectal cancer surgery [1-2]. Pelvic floor closure during surgery can not only protect abdominal organs and presacral wounds, but also help to control infection, limit inflammation, and reduce the occurrence of postoperative complications such as adhesive intestinal obstruction [3]. The accompanying video reports a novel surgical method to close the pelvic floor by turning over the autologous peritoneal wall during the operation, with good postoperative recovery. The advantages of this surgery are low cost, convenient sampling, rapid repair, and reduced risk of infection [4]. It is a simple, safe, economical, minimally invasive, and highly feasible surgical method, which can achieve good patient recovery.","manuscriptTitle":"Closure of Pelvic Floor Entrance With Autogenous Peritoneum Flipping","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-04-26 13:49:10","doi":"10.21203/rs.3.rs-4284988/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"f86fe949-0369-43d9-a5a1-6b7a9d47fd9e","owner":[],"postedDate":"April 26th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-11-19T02:08:46+00:00","versionOfRecord":[],"versionCreatedAt":"2024-04-26 13:49:10","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4284988","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4284988","identity":"rs-4284988","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}