title: Laparoscopic pelvic mesh placement with closure of pelvic floor entrance to prevent small intestine radiation trauma - A retrospective cohort analysis.
abstract: BACKGROUND
  In most pelvic malignancies radiation therapy is a main part of the treatment concept. The main dose limiting organ is the small intestine. Different mechanical methods to prevent radiation damage to the small intestine have been described. We herein report a retrospective study of laparoscopic placement of an absorbable vicryl mesh in patients requiring pelvic radiotherapy displacing the bowel out of the radiation field.
  
  
  METHODS
  The study included 6 consecutive patients requiring definitive radiotherapy due to locally advanced prostate cancer. All patients had small intestine within the radiation fields despite the use of non-invasive displacement methods.
  
  
  RESULTS
  All patients underwent laparoscopic small bowel displacement from the pelvis and closure of the pelvic floor entrance using vicryl mesh placement. Peri- or postoperative complications were not seen. Postoperative radiotherapy planning CT scans confirmed displacement of the small intestine allowing all patients to receive the planned radiotherapy volume.
  
  
  CONCLUSIONS
  Laparoscopic mesh placement represents a safe and efficient procedure in patients requiring high-dose pelvic radiation, presenting with unacceptable small intestine volume in the radiation field. As an alternate to native tissue, the vicryl mesh is a safe, effective substitute for small bowel exclusion from external-beam radiation therapy.
authors.affiliation: Department of General, Visceral and Transplantation Surgery, University of Tübingen, Hoppe-Seyler Str. 3, 72076 Tübingen, Germany.
authors.forename: R
authors.initials: R
authors.lastname: Bachmann
authors.affiliation: Department of Radiation Oncology, University of Tuebingen, Hoppe-Seyler-Str. 3, 72076 Tuebingen, Germany.
authors.forename: F
authors.initials: F
authors.lastname: Heinzelmann
authors.affiliation: Department of Radiation Oncology, University of Tuebingen, Hoppe-Seyler-Str. 3, 72076 Tuebingen, Germany.
authors.forename: A C
authors.initials: AC
authors.lastname: Müller
authors.affiliation: Department of General, Visceral and Transplantation Surgery, University of Tübingen, Hoppe-Seyler Str. 3, 72076 Tübingen, Germany.
authors.forename: R
authors.initials: R
authors.lastname: Ladurner
authors.affiliation: Department of General, Visceral and Transplantation Surgery, University of Tübingen, Hoppe-Seyler Str. 3, 72076 Tübingen, Germany.
authors.forename: C C
authors.initials: CC
authors.lastname: Schneider
authors.affiliation: Department of General, Visceral and Transplantation Surgery, University of Tübingen, Hoppe-Seyler Str. 3, 72076 Tübingen, Germany.
authors.forename: A
authors.initials: A
authors.lastname: Königsrainer
authors.affiliation: Department of General, Visceral and Transplantation Surgery, University of Tübingen, Hoppe-Seyler Str. 3, 72076 Tübingen, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Zdichavsky
mesh_terms: D020341:Absorbable Implants; D000368:Aged; D006801:Humans; D007421:Intestine, Small / Q000293:injuries / Q000528:radiation effects*; D010535:Laparoscopy / Q000379:methods; D008297:Male; D008875:Middle Aged; D059351:Organ Sparing Treatments / Q000379:methods*; D058958:Organs at Risk / Q000528:radiation effects; D017773:Pelvic Floor / Q000601:surgery*; D011098:Polyglactin 910; D011471:Prostatic Neoplasms / Q000532:radiotherapy; D011829:Radiation Dosage; D011832:Radiation Injuries / Q000209:etiology / Q000517:prevention & control*; D011878:Radiotherapy / Q000009:adverse effects; D011879:Radiotherapy Dosage; D012189:Retrospective Studies; D013526:Surgical Mesh
chemical_list: D011098:Polyglactin 910
keywords: Bowel radiation damage; Laparoscopic placement; Pelvic mesh