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Published on: February 12, 2022
Surgical Strategy for En Bloc Iliacoinguinal Resection and Reconstruction Using Myopectineal Orifice Repair
Song Yang1, Yao Lu2, Huan Peng2
1Department of General Surgery, No. 991 Hospital of the Joint Logistics Support Force, PLA, Xiangyang, China.
Background:
Anterior and lateral pelvic tumors may extend into the iliacoinguinal region and require wide en bloc resection. When resection includes the inguinal ligament, lower abdominal wall, and-in selected cases-the external iliac vessels, reconstruction must restore a mechanically demanding abdomen-groin junction while protecting major neurovascular structures. We describe an MPO-based reconstructive strategy and report early outcomes.
Methods:
We retrospectively reviewed six consecutive patients who underwent en bloc iliacoinguinal resection and reconstruction between January and December 2024. Reconstruction followed preperitoneal MPO repair principles, including a mesh-based inguinal ligament substitute, peritoneal envelope ("visceral sac") reconstruction when required, abdominal wall reinforcement, and femoral canal/oval fossa dead-space management. Prosthetic graft reconstruction was performed when the external iliac vessels were resected.
Results:
All patients completed the planned procedure. Inguinal ligament substitute reconstruction was performed in 6/6 patients, peritoneal envelope reconstruction in 5/6, and external iliac vessel resection with reconstruction in 4/6. Mean operative time was (375.83 ± 129.63) min and estimated blood loss was (433 ± 245.95) mL. Mean time to first flatus was (4 ± 0.89) days and length of stay was (8.67 ± 4.37) days. Pathology confirmed R0 resection in all cases. One patient developed an oval fossa seroma that resolved with repeated aspiration; two had transient mild lower-limb edema. No limb ischemia/necrosis, enteric fistula, bowel obstruction/ileus, or early abdominal wall hernia occurred during early follow-up.
Conclusions:
MPO-based reconstruction after en bloc iliacoinguinal resection is feasible and appears safe in the short term. A stepwise approach that restores a groin anchor, re-establishes compartment separation, reinforces the abdominal wall, and manages femoral dead space may improve early junctional stability.
