VM26 - Pelvic Floor Omental Flap During Laparoscopic Abdominoperineal Resection

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Purpose/Background: The potential effects of pedicle omentoplasty after abdominoperineal resection is still controversial. This technique may help fill the pelvis, and therefore, potentially impact wound complications.
This is the case of a female patient with low rectal cancer, undergoing laparoscopic abdominoperineal resection. This video focuses on the omental flap technique, used to close the pelvic floor afterwards, with step-by-step guidance during both the abdominal and the perineal approach of this procedure.

Methods/Interventions: Once the laparoscopic part of the proctectomy has been completed, the transverse colon is mobilized from the omentum. The omental bursa is reached, and the right gastroepiploic vessels are identified. These vessels are carefully dissected and ligated. The omentum is dissected from the greater curvature to obtain full mobilization of the omental flap, which will be vascularized by the preserved left gastroepiploic pedicle and its arcade. The flap is brought down to the pelvis, passing laterally to the descending colon that has been lifted through the abdominal wall to form the end colostomy. The distal part of the flap is tied to the sigmoid transection line with an endoloop. A drain is temporarily placed in the pelvis. The perineal dissection is completed and the specimen is exteriorized through the perineum. The flap is detached from the specimen and placed at the pelvic floor, right in front of the drain. The omentum is sutured thoroughly with the pelvic muscles. The perineum is closed with three layers of additional sutures.

Results/Outcomes: Ultimately, the pelvic floor was filled and closed with a well-vascularized and tension-free pedicle omental flap and the perineum was sealed with a multiple-layer closing technique.

Conclusion/Discussion: Omental flap creation is easily and efficiently feasible during laparoscopic abdominoperineal resection.