Novel technique with bladder peritoneum to prevent empty pelvic syndrome after laparoscopic pelvic exenteration for gynecologic malignancies Three case reports

Rationale: Pelvic exenteration (PE) is a radical surgical procedure for treating locally recurrent or uncontrolled pelvic malignancies. The consequent postoperative pelvic dead space presents a challenge to extirpative surgeons. Many methods have been utilized for pelvic floor reconstruction to reduce related postoperative complications, however, none of them have been widely accepted. Patient concerns: Here, we report 3 cases of patients who underwent PE. Case 1 was a 36-year-old woman who presented to our hospital with abnormal vaginal bleeding. Case 2 was a 50-year-old woman with recurrence of stage IIB squamous cell carcinoma of the cervix. Case 3 was a 54-year-old woman with uncontrolled stage IIB adenocarcinoma of the cervix. The last 2 patients were both treated with radiotherapy and chemotherapy previously. Diagnosis: Biopsy results revealed adenocarcinoma of the vagina, squamous cell carcinoma of the cervix, and adenocarcinoma of the cervix in Case 1, 2, and 3 respectively. Interventions: We describe a safe and effective approach that employs the preservation of the bladder peritoneum to eliminate the pelvic dead space following laparoscopic PE, with or without partial utilization of the greater omentum. Outcomes: Three patients with gynecologic cancer underwent this operation and developed no intraoperative or postoperative complications. Conclusion: Our experience suggests that laparoscopic PE using the bladder peritoneal barrier to cover the denuded pelvic cavity is a reasonable choice to decrease the risk of empty pelvic syndrome.