Addressing the empty pelvic syndrome following total pelvic exenteration: does mesh reconstruction help?

Area of Science:

• Surgical Oncology
• Pelvic Reconstruction
• Wound Complication Management

Background:

• Perineal wound complications and pelvic abscesses are significant morbidities following total pelvic exenteration.
• The pelvic void created by multi-visceral resections can lead to fluid accumulation, bowel translocation, and increased risk of complications like abscesses and wound dehiscence.

Purpose of the Study:

• To describe a novel technique using degradable synthetic mesh with omentum to fill the pelvic void after total pelvic exenteration.
• To investigate the rates of pelvic abscess and perineal wound complications using this mesh reconstruction method.

Main Methods:

• Ten patients undergoing total pelvic exenteration received implantation of degradable synthetic mesh.
• The mesh was contoured to the bony pelvis, and data on postoperative complications, including pelvic abscesses and perineal wound issues, were collected.

Main Results:

• No perioperative mortality was observed.
• 50% of patients experienced postoperative complications, including one pelvic abscess requiring drainage and two intra-abdominal collections needing percutaneous drainage.
• No perineal hernias or entero-perineal fistulas were detected at a median follow-up of 7 months.

Conclusions:

• Degradable synthetic mesh reconstruction after exenterative surgery may decrease postoperative complications associated with the perineal wound.
• This technique shows potential for improving outcomes in patients undergoing extensive pelvic resections.