Mesenteric hammock for retaining the small intestine after radical pelvic surgery

The small bowel often partakes in complications seen after major colorectal and other pelvic operations. Trapped loops of small intestine within the pelvic basin may produce benign adhesive obstruction and are also exposed to recurrent malignancy. These problems may be compounded by the effects of radiotherapy. To reduce some of these complications, many methods have been devised to reconstruct the pelvic floor and thereby retain the small intestine within the abdominal cavity. Autogenous material such as omentum and peritoneal flaps have been employed as a substitute for the excised peritoneal pelvic lining. However, these methods may not be feasible in some reoperated patients, especially if prior irradiation has induced extensive peritoneal fibrosis, or if the omentum is absent or attenuated. We describe a technique in which the small-bowel mesentery is used as a hammock across the pelvic brim in order to support the small intestine out of the pelvic cavity. It has been used successfully in patients with complications after abdominoperineal resection for carcinoma of the rectum: one enterovaginal fistula associated with radiation injury and cancer, and three enteroperineal fistulas.