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The Small Bowel in Its Hammock: How to Avoid Irradiation Thanks to the Sigmoid
- Source :
- Journal of Laparoendoscopic & Advanced Surgical Techniques. 25:77-80
- Publication Year :
- 2015
- Publisher :
- Mary Ann Liebert Inc, 2015.
-
Abstract
- High-dose irradiation is the cornerstone treatment of bone cancers of the pelvic rim. To protect the small bowel from irradiation and following consequences, we described the laparoscopic use of the sigmoid to perform a hammock.Three patients were diagnosed with metastatic Ewing's sarcoma, localized malignant peripheral nerve sheath tumor, and localized BCOR-CCNB3 (Ewing-like) sarcoma of the pelvic rim at 13.1, 5.7, and 12.9 years, respectively. After neoadjuvant chemotherapy, the 2 female patients underwent a hemisacrectomy under S2 only by the posterior approach, whereas no orthopedic surgery was required for the male patient because of excellent local response to chemotherapy. A 54-Gy intensity-modulated radiotherapy of the posterior part of the pelvis was intended for all patients.The laparoscopic procedure consisted in the fixation of the sigmoid loop to the anterior parietal wall on a transverse line just below the umbilicus, associated with a colostomy in the right iliac fossa. The anterior transposition of the two ovaries, uterus, and rectum and the dissection of left iliac vessels to move them anteriorly were added in female patients. Stomas were closed around 6 months after completion of the radiotherapy course, associated with the repositioning of the uterus, ovaries, and colon. With a mean follow-up of 22 months, all patients are alive without any recurrences or radiation-related symptoms.The laparoscopic "hammock technique" both protects the small bowel from irradiation and secures the orthopedic procedure by displacing the abdominal organs forward.
- Subjects :
- Adult
Male
medicine.medical_specialty
Adolescent
medicine.medical_treatment
Umbilicus (mollusc)
Bone Neoplasms
Malignant peripheral nerve sheath tumor
Sarcoma, Ewing
Colon, Sigmoid
Colostomy
Intestine, Small
medicine
Humans
Pelvic Bones
Radiation Injuries
Neoadjuvant therapy
Pelvis
Aged
Fixation (histology)
business.industry
Middle Aged
medicine.disease
Neoadjuvant Therapy
Surgery
Radiation therapy
medicine.anatomical_structure
Child, Preschool
Orthopedic surgery
Female
Laparoscopy
Sarcoma
Neoplasm Recurrence, Local
business
Subjects
Details
- ISSN :
- 15579034 and 10926429
- Volume :
- 25
- Database :
- OpenAIRE
- Journal :
- Journal of Laparoendoscopic & Advanced Surgical Techniques
- Accession number :
- edsair.doi.dedup.....b2404d4915d1f9572ef94a87a41220e6
- Full Text :
- https://doi.org/10.1089/lap.2014.0270