Readaptation of the peritoneum following extended pelvic lymphadenectomy and cystectomy has a significant beneficial impact on early postoperative recovery and complications: results of a prospective randomized trial.
BACKGROUND
Prolonged postoperative pain and delayed intestinal transit are frequent problems following extended pelvic lymph-node dissection (PLND) and cystectomy.


OBJECTIVE
To evaluate the impact of bilateral readaptation of the dorsolateral peritoneal layer on postoperative pain, gastrointestinal recovery, and complications following extended PLND and cystectomy.


METHODS
Randomized, single-blinded, single-center study of 200 consecutive cystectomy patients.


METHODS
In group A (n=100), lateral peritoneal flaps ventral to the external iliac vessels were bilaterally rotated over the iliac vessels down to the distal obturator fossa and medially fixed to the pararectal peritoneal layer following extended PLND and cystectomy. In group B (n=100), the peritoneal layer was not readapted.


METHODS
Pain according to the visual analog scale (VAS), amount of peridural anesthetics needed, and gastrointestinal activity were assessed on postoperative days 1, 3, and 7. Complications occurring within 30 d following surgery were documented.


CONCLUSIONS
Readaptation of the dorsolateral peritoneal layer resulted in a significant decrease in pain (p<0.01) with concurrent significantly reduced need for peridural anesthetics (p<0.01). Flatulence and first passage of stool as signs of intestinal transit were noted earlier in group A than in group B. Gastrostomy tube and peridural catheter could be removed 1 d earlier in group A than in group B (postoperative days 7 vs 8 and 6 vs 7, respectively). Group A (30%) had fewer complications than group B (56%; p<0.001).


CONCLUSIONS
Readaptation of the dorsolateral peritoneal layer after extended PLND and cystectomy resulted in significantly less postoperative pain, earlier recovery of bowel function, and fewer complications in the early postoperative period.
Department of Urology, University of Bern, Bern, Switzerland.
Beat
B
Roth
Frédéric D
FD
Birkhäuser
Pascal
P
Zehnder
Fiona C
FC
Burkhard
George N
GN
Thalmann
Urs E
UE
Studer
D000222:Adaptation, Physiological / Q000502:physiology; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015653:Cystectomy; D005260:Female; D005500:Follow-Up Studies; D041981:Gastrointestinal Tract / Q000502:physiology; D006801:Humans; D008197:Lymph Node Excision; D008297:Male; D008875:Middle Aged; D010149:Postoperative Pain / Q000503:physiopathology*; D010537:Peritoneum / Q000502:physiology / Q000601:surgery*; D011446:Prospective Studies; D020127:Recovery of Function / Q000502:physiology*; D001749:Urinary Bladder Neoplasms / Q000503:physiopathology / Q000601:surgery*; D014547:Urinary Diversion