Eureka: objective assessment of the empty pelvis syndrome to measure volumetric changes in pelvic dead space following pelvic exenteration.

IF 2.7 3区 医学 Q2 GASTROENTEROLOGY & HEPATOLOGY Techniques in Coloproctology Pub Date : 2024-06-26 DOI:10.1007/s10151-024-02952-0
C T West, A Tiwari, L Matthews, I Drami, D V C Mai, J T Jenkins, H Yano, M A West, A H Mirnezami
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Abstract

Background: Large tissue defects following pelvic exenteration (PE) fill with fluid and small bowel, leading to the empty pelvis syndrome (EPS). EPS causes a constellation of complications including pelvic sepsis and reduced quality of life. EPS remains poorly defined and cannot be objectively measured. Pathophysiology of EPS is multifactorial, with increased pelvic dead space potentially important. This study aims to describe methodology to objectively measure volumetric changes relating to EPS.

Methods: The true pelvis is defined by the pelvic inlet and outlet. Within the true pelvis there is physiological pelvic dead space (PDS) between the peritoneal reflection and the inlet. This dead space is increased following PE and is defined as the exenteration pelvic dead space (EPD). EPD may be reduced with pelvic filling and the volume of filling is defined as the pelvic filling volume (PFV). PDS, EPD, and PFV were measured intraoperatively using a bladder syringe, and Archimedes' water displacement principle.

Results: A patient undergoing total infralevator PE had a PDS of 50 ml. A rectus flap rendered the pelvic outlet watertight. EPD was then measured as 540 ml. Therefore there was a 10.8-fold increase in true pelvis dead space. An omentoplasty was placed into the EPD, displacing 130 ml; therefore, PFV as a percentage of EPD was 24.1%.

Conclusions: This is the first reported quantitative assessment of pathophysiological volumetric changes of pelvic dead space; these measurements may correlate to severity of EPS. PDS, EPD, and PFV should be amendable to assessment based on perioperative cross-sectional imaging, allowing for potential prediction of EPS-related outcomes.

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Eureka:客观评估空骨盆综合征,测量骨盆外展后骨盆死腔的体积变化。
背景:骨盆外扩张术(PE)后的大块组织缺损会充满液体和小肠,导致空骨盆综合征(EPS)。EPS 会导致一系列并发症,包括骨盆败血症和生活质量下降。EPS 的定义尚不明确,也无法进行客观测量。EPS 的病理生理学是多因素的,其中骨盆死腔的增加可能是重要因素。本研究旨在描述客观测量与 EPS 相关的体积变化的方法:真正的骨盆由骨盆入口和出口定义。在真骨盆内,腹膜反射和入口之间存在生理性骨盆死腔(PDS)。这种死腔在 PE 之后会增大,并被定义为腹腔外骨盆死腔(EPD)。EPD 可随骨盆充盈而减少,充盈量被定义为骨盆充盈容积 (PFV)。使用膀胱注射器和阿基米德水位移原理在术中测量 PDS、EPD 和 PFV:结果:一名接受全腹壁下腹腔镜手术的患者的 PDS 为 50 毫升。直肌瓣使骨盆出口不漏水。然后测得 EPD 为 540 毫升。因此,真正的骨盆死腔增加了 10.8 倍。在EPD中植入网膜成形术,置换出130毫升;因此,PFV占EPD的百分比为24.1%:这是首次报道对骨盆死腔的病理生理容积变化进行定量评估;这些测量结果可能与 EPS 的严重程度相关。PDS、EPD和PFV应可根据围手术期横断面成像进行评估,从而对EPS相关结果进行潜在预测。
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来源期刊
Techniques in Coloproctology
Techniques in Coloproctology GASTROENTEROLOGY & HEPATOLOGY-SURGERY
CiteScore
5.30
自引率
9.10%
发文量
176
审稿时长
1 months
期刊介绍: Techniques in Coloproctology is an international journal fully devoted to diagnostic and operative procedures carried out in the management of colorectal diseases. Imaging, clinical physiology, laparoscopy, open abdominal surgery and proctoperineology are the main topics covered by the journal. Reviews, original articles, technical notes and short communications with many detailed illustrations render this publication indispensable for coloproctologists and related specialists. Both surgeons and gastroenterologists are represented on the distinguished Editorial Board, together with pathologists, radiologists and basic scientists from all over the world. The journal is strongly recommended to those who wish to be updated on recent developments in the field, and improve the standards of their work. Manuscripts submitted for publication must contain a statement to the effect that all human studies have been reviewed by the appropriate ethics committee and have therefore been performed in accordance with the ethical standards laid down in an appropriate version of the 1965 Declaration of Helsinki. It should also be stated clearly in the text that all persons gave their informed consent prior to their inclusion in the study. Details that might disclose the identity of the subjects under study should be omitted. Reports of animal experiments must state that the Principles of Laboratory Animal Care (NIH publication no. 86-23 revised 1985) were followed as were applicable national laws (e.g. the current version of the German Law on the Protection of Animals). The Editor-in-Chief reserves the right to reject manuscripts that do not comply with the above-mentioned requirements. Authors will be held responsible for false statements or for failure to fulfill such requirements.
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