Introduction: The incidence of bowel obstruction after rectal resection is approximately 6-10%. It may be an underestimate (detection bias). About half of them need laparotomy. We believe the dominant cause lies in pelvic incarceration of bowel loops. Greater omentum has been used for multiple indications in surgery however the data for its use in rectal surgery is practically non-existent. The aim of this paper is to describe our technique of (random pattern) omental pedicle shelf (OPS) created by preserving the left gastroepiploic artery and to see the safety/feasibility-related initial results i.e. post-op bowel obstruction (primary outcome) and mortality, morbidity, operative time, flap failure and return of GI function (secondary outcomes).
Patients & Methods: Seventeen consecutive patients requiring rectal resection and division below the peritoneal reflection and who were operated for anterior resection or abdominoperineal excision of rectum (APR) had the OPS placed in the pelvis after the anastomosis. M: F ratio was 1.1:1, median age=67y iqr=59-76 range=47-87. Majority belonged to BMI of 25-29 and ASA-II. The indication was rectal cancer in 14/17 and benign conditions in 3/17. There were 14 anterior resections and three APRs. The OPS was a random pattern flap devised by preserving the left gastroepiploic artery and requiring three steps: omental mobilization, lengthening and transfer. Adjunct operations included no stoma (n=5), covering loop ileostomy (n=7), colostomy (n=3), previously made loop ileostomy (n=1) and colostomy (n=1). Photos & video shall be presented.
Results: The procedure was technically simple. The median operative time was 10min (iqr=10-15 range=8-20min). Median time to return of bowel activity=one day (range 1-2), to ambulation=1 day (range=1-2). There has been no event of bowel obstruction. The complications included Clavien 0=15, I=0, II=0, III=2 (splenectomy n=1, anastomotic leak n=1) and Clavien IV=1 (30-day mortality due to multi-organ failure secondary to pulmonary complications). There was no OPS-related complication. Median length of stay was seven days (iqr=7-8 range=7-11 days). Median follow-up was three months. The stoma has been closed in two patients.
Expected results: For statistical significance approximately 40 patients are needed with 0% incidence of bowel obstruction.
Conclusion: Initial results of OPS revealed it to be a safe and simple procedure with no OPS-related complication, no case of post-op bowel obstruction and with likely secondary benefits.
Program Number: P089