대한대장항문학회

A large pelvic dead space after abdominoperineal resection(APR) has been serious<br>problems to the patients. Perineal wound healing takes a long time, particulary in<br>previously pelvic irradiated patients. In addition, postoperative intestinal obstruction due<br>to the intestinal herniation into the pelvic dead space is one of the fatal complications.<br>The obliteration of the dead space with an omental pedicle graft is mainly intended to<br>provide a better postoperative course. The purpose of the present study is to describe<br>the technique and evaluate the results of Pelvic filling with pedicled omentum after<br>APR. A clinical analysis has been conducted for 113 cases treated by APR at the<br>surgical department, Kyung Hee University Hospital from January 1980 to December<br>1992. From Jan. 1980 to Dec. 1986 as Period Ⅰ, authors performed conventional<br>reconstruction of the Pelvic peritoneum and drainage procedures. And from Jan. 1987 to<br>Dec. 1992 as period Ⅱ, authors have tried pedicled omental graft for the obliteration of<br>the pelvic dead space during on the procedure of APR. The greater omentum was<br>mobilized as a pedicle graft based on the left gastroepiploic arcade and transposed to the<br>pelvic cavity. In Period Ⅱ, all perineal wounds were closed primarily without perineal<br>drainage. Accordingly, authors have experienced that most of the patients in period Ⅱ<br>presented shortened hospitalization, clean perineal wound healing, and reduced<br>complications such as intestinal obstruction, pelvic hematoma formation with or without<br>abscess compared with patients in period I. Omentoplasty is a simple, safe and effective<br>adjunct to rectal surgery. The additional time taken(15∼20 min) is well rewarded by<br>sound postoperative progress of this operation.<br>