title: The small bowel in its hammock: how to avoid irradiation thanks to the sigmoid.
abstract: BACKGROUND
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  The laparoscopic "hammock technique" both protects the small bowel from irradiation and secures the orthopedic procedure by displacing the abdominal organs forward.
authors.affiliation: 1 Department of Paediatric Surgery, Hôpital Necker Enfants Malades, Paris Descartes University , Paris, France .
authors.forename: Sabine
authors.initials: S
authors.lastname: Irtan
authors.forename: Eric
authors.initials: E
authors.lastname: Mascard
authors.forename: Stéphanie
authors.initials: S
authors.lastname: Bolle
authors.forename: Laurence
authors.initials: L
authors.lastname: Brugières
authors.forename: Sabine
authors.initials: S
authors.lastname: Sarnacki
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001859:Bone Neoplasms / Q000532:radiotherapy*; D002675:Child, Preschool; D012809:Colon, Sigmoid / Q000601:surgery*; D003125:Colostomy / Q000379:methods; D005260:Female; D006801:Humans; D007421:Intestine, Small / Q000528:radiation effects*; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009364:Neoplasm Recurrence, Local; D010384:Pelvic Bones; D011832:Radiation Injuries / Q000517:prevention & control*; D012512:Sarcoma, Ewing / Q000532:radiotherapy*