title: Novel para-aortic lymphadenectomy technique for gynecological malignancies prevents postoperative bowel obstruction.
abstract: OBJECTIVE
  The aim of this study was to evaluate the effect of our novel technique on the prevention of postoperative ileus in patients undergoing systematic para-aortic lymphadenectomy (PALN).
  
  
  METHODS
  PALN was performed in 135 gynecological cancer patients (67 with ovarian cancer, 58 with endometrial cancer, 8 with serous surface papillary adenocarcinoma (SSPC) and 2 with fallopian tube cancer) between 2006 and 2011. To prevent postoperative ileus, we performed our novel technique wherein the small bowel and colon are released from pressure and soaked in 2 L of physiological saline for 1 min every 20 min during the lymphadenectomy. We indicated our novel PALN technique and retrospectively analyzed the outcomes of the surgical procedure in terms of the surgical data, and postoperative incidence of gastrointestinal dysfunction in patients with gynecological malignancies.
  
  
  RESULTS
  The mean blood loss was 641.2 ± 800.3 mL in the PALN group and 313.9 ± 278.9 mL in the pelvic lymphadenectomy (PLN) without PALN group (P < 0.0001). There was no difference in the first passage of flatus between the PALN group and the PLN group (1.8 ± 0.7 days vs 1.6 ± 0.7 days). The mean time to tolerance of a regular diet was significantly longer in the PALN group than in the PLN group (P < 0.0001), whereas the incidence of vomiting was similar in both groups. Surprisingly, there were no cases of postoperative ileus in either group.
  
  
  CONCLUSIONS
  Our novel technique is a safe and effective way to prevent the incidence and decrease the severity of postoperative ileus after PALN for gynecological malignancies.
authors.affiliation: Department of Obstetrics and Gynecology, Osaka Medical College, Osaka, Japan. y-terai@poh.osaka-med.ac.jp
authors.forename: Yoshito
authors.initials: Y
authors.lastname: Terai
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Sasaki
authors.forename: Satoshi
authors.initials: S
authors.lastname: Tsunetoh
authors.forename: Yoshimichi
authors.initials: Y
authors.lastname: Tanaka
authors.forename: Saha
authors.initials: S
authors.lastname: Yoo
authors.forename: Satoe
authors.initials: S
authors.lastname: Fujiwara
authors.forename: Masanori
authors.initials: M
authors.lastname: Kanemura
authors.forename: Masahide
authors.initials: M
authors.lastname: Ohmichi
mesh_terms: D005260:Female; D005500:Follow-Up Studies; D005833:Genital Neoplasms, Female / Q000601:surgery*; D006801:Humans; D045823:Ileus / Q000517:prevention & control; D015994:Incidence; D007415:Intestinal Obstruction / Q000453:epidemiology / Q000503:physiopathology / Q000517:prevention & control*; D007422:Intestines / Q000098:blood supply; D007564:Japan / Q000453:epidemiology; D008197:Lymph Node Excision / Q000379:methods*; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology / Q000503:physiopathology / Q000517:prevention & control*; D012189:Retrospective Studies; D012720:Severity of Illness Index