The use of silicone expander and cecal transposition after pelvic exenteration.
OBJECTIVE
Describe a new approach for pelvic floor treatment employing a temporary mechanical support device with silicone expander, with or without association to cecal transposition.


METHODS
From January 2000 to June 2006, 106 patients were submitted to pelvic exenteration. A retrospective evaluation was done of the last 30 patients previously submitted to total pelvic exenteration without neither urinary nor faecal sphincter preservation who latter were submitted to a pelvic floor treatment with silicone expander with or without association to cecal rotation.


RESULTS
Twenty-six patients were female and four male. The most common primary neoplasm site were of gynecological origin (20 cases). The median follow-up period was 12 months (0.36-38). Only one patient presented small intestine loops slipping after expander removal. No other patient had small intestine loops slippage into the pelvis, probably because of cecal transposition. All patients were submitted to a post-operative CT scan to confirm that intestinal loops remained out of the pelvis. Six patients presented pelvic hollow infection after device removal. All cases had complete resolution with local cleaning using physiological solution associated with systemic antibiotic therapy, except one who needed a trans-abdominal surgical approach.


CONCLUSIONS
Pelvic floor treatment employing a temporary mechanical support device with silicone expander, associated or not to cecal transposition is a low-morbidity procedure. The most common complication is pelvic floor infection, but maintaining a cutaneous perineal hole allows easy access and treatment of possible pelvic abscesses as well as early recurrence diagnosis.
Guimarães
G C
GC
Department of Pelvic Surgery of Centro de Tratamento e Pesquisa Hospital do Câncer A.C. Camargo, Professor Antonio Prudente, 211, Liberdade, São Paulo 01509-010, Brazil. guimaraesgc@uol.com.br
Baiocchi
G
G
Rossi
B M
BM
Ferreira
F O
FO
Aguiar
S
S
Nakagawa
W T
WT
Lopes
A
A
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002432:Cecum / Q000601:surgery; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010385:Pelvic Exenteration; D010386:Pelvic Neoplasms / Q000556:secondary / Q000601:surgery*; D012828:Silicones; D015625:Tissue Expansion Devices
D012828:Silicones