LAUSR

Pelvic exenteration is a challenging procedure with the goal of removing enbloc pelvic organs. It is mainly performed for central recurrent gynecologic malignancies and is associated with high rates of postoperative morbidity. One of the main complications of this procedure is the empty pelvis syndrome. The empty space created after the surgery leads to fluid accumulation and small bowel adherence to the pelvic floor, leading to fistula formation, pelvic abscess, or chronic infection. To prevent this, Rutledge and colleagues first described in 1977 their technique of the omental flap. Other techniques involving musculocutaneous flaps have been described that aim to increase vascularization of the pelvis. However, these techniques can be challenging, skill demanding, and may not be adequate for patients with a numerous comorbidities or in the abscense of the omentum. Many have explored easier strategies to address this complication, with less demanding techniques. Mammary implants have been used by several groups. Recently in this journal, two video articles 4 have been published by two different groups showing the use of this technique. However, results of this technique in the surgical literature can be found only in one small cohort, involving 56 patients. One of the most frequent complications described after the surgery in that study was the pelvic or prosthesis infections in four cases. In all cases, prosthesis removal was unnecessary and patients were treated with pelvic lavage and systemic antibiotic. Periprosthesis hematoma was reported in two patients with subsequent rectal stump evacuation. Intestinal leak was reported in four patients, in two patients the prothesis was removed and repositioned, and there were no further complications. No enterocutaneous fistulas or episodes of intestinal obstruction were reported. There is yet no ideal option for the treatment of empty pelvis syndrome after exenteration in patients with gynecologic cancers. However, in complex patients where a flap of either omentum or other tissues cannot be used, the use of prosthetic material, such as a breast implant, shows promising results that need to be further evaluated in the future.