BACKGROUND: The abdominoperineal resection was a standard method for low-rectum carcinoma treatment. It was associated with significant mortality and morbidity which were decreasing with the development of preoperative diagnostic procedures, new surgical techniques and new surgical instruments.
AIM: Pelvic peritonization is important prevention of postoperative adhesions and postoperative irradiations of terminal ileum for patients who need postoperative adjuvant radiotherapy.
METHODS: The pelvic pertionization is performed after laparoscopic recto-sigmoid extirpation, using extended absorbable intracorporeal suture with the titanic clips application after every second suture. The role of titanic clip is to grasp the extended suture and to mark the postoperative irradiation field for significant prevention of postirradiatic enteritis.
RESULTS: We operated 261patients with benign or malignant large intestine disease from December 12th 2002 to December1st 2008, using laparoscopic procedure. The laparoscopic abdominoperineal rectum amputation (LAPA) with lapoaroscopic pelvic peritonization was performed in 21of those patients (14 Dukes B, 7 Dukes C). Average age was 72 years (58-82). The perineal aspirate drainage was performed in all patients. The antibiotic and thrombotic prophylaxis was prescribed to all patients, too. There were no postoperative complications.
CONCLUSION: The laparoscopic pelvic peritonization after laparoscopic abdominoperineal rectum amputation is a simple procedure with extremely clinical importance in adhesions and postirradiatic enteritis prevention. The LAPA procedure can satisfy all oncological and minimal invasive surgery principles and it’s acceptable in every patient where rectum amputation is indicated.
Program Number: P136