The Application of Extraperitoneal Ostomy Combined with Pelvic Peritoneal Reconstruction in Laparoscopic Abdominoperineal Resection for Rectal Cancer.

Background: Due to the technical difficulty, it is not common to close the pelvic peritoneum in laparoscopic abdominoperineal resection (LAPR) in China, which increases the risk of related complications. Permanent sigmoid colostomy is performed through the transperitoneal route conventionally in LAPR. This leads to the high occurrence of parastomal hernias and bowel obstructions. To prevent the complications and reduce surgical costs of LAPR, we performed some modifications for it.

Methods: 38 patients diagnosed with low rectal cancer during July 2014 to July 2016 received LAPR with our modifications. First, the mobilization of the rectum and lymphadenectomy were identical to the classical routine method. Second, two sutures were performed on the pelvic peritoneum with the first to reduce the tension, followed by the second continuous suture to close the pelvic floor. Third, a tunnel was made between the parietal peritoneum and abdominal wall for the end sigmoid to pass through to finish the colostomy.

Results: LAPR was performed on totally 38 patients successfully with no case transferring to open surgery. The follow-up period was from 1 month to 1 year. The mean operative time was 142.2 ± 16.5 min ranging from 100 min to 175 min. The mean hospital stay was 12.0 ± 1.5 days. No case underwent the reconstruction of stoma. There was not a single complication of LAPR with these two techniques that occurred to all 38 patients.

Conclusion: We consider LAPR with our two techniques feasible and safe, which can be accepted quickly to improve the life quality of patients. Therefore, we suggest our procedures as the first choice during LAPR surgery. This trial is registered with trial registration number 2014028.