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The Small Bowel in Its Hammock: How to Avoid Irradiation Thanks to the Sigmoid

Authors :
Eric Mascard
Stéphanie Bolle
Sabine Irtan
Laurence Brugières
Sabine Sarnacki
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.

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