Long-term follow-up of pelvic peritoneum reconstruction with bladder peritoneum flap after extralevator abdominoperineal excision.

Authors

Yu Shen, Tinghan Yang, Huan Ren, Zhao Zhang, Xiangbing Deng, Mingtian Wei, Wenjian Meng, Ziqiang Wang

Published in

Updates in surgery. Jul 07, 2026. Epub Jul 07, 2026.

Abstract

Laparoscopic extralevator abdominoperineal excision (L-ELAPE) for low-located rectal cancer may leave a dead presacral space, which may cause empty pelvis syndrome (EPS) and perineal hernia (PH). Bladder peritoneum flap reconstruction (BLAPER) is a novel pelvic peritoneum reconstruction technique that may partition the abdominal and pelvic cavity and thus prevent the occurrence of EPS and PH. This study aimed to determine the long-term safety and efficacy of the BLAPER technique to prevent the occurrence of PH and small bowel obstruction (SBO) for rectal cancer patients who underwent L-ELAPE. We conducted a prospective single-arm study. Patients who were diagnosed with low rectal cancer and underwent L-ELAPE with BLAPER procedure were included. The primary endpoints were the occurrence of long-term postoperative complications, including PH and SBO. From April 2017 to June 2022, a total of 26 patients underwent L-ELAPE with a successful BLAPER procedure. The median follow-up time was 47 (13-64) months. No PH was found during the follow-up, with a 3.8% (1/26) incidence of SBO. Three patients (3/25, 12%) had severe urinary dysfunction according to the International Prostatic Symptom Score (IPSS) system. BLAPER is a safe procedure to separate the abdominal and pelvic cavity after L-ELAPE surgery and may prevent the occurrence of PH and SBO. For low rectal cancer patients who undergo L-ELAPE, BLAPER may be an optional pelvic peritoneum reconstruction technique when the primary suture of pelvic peritoneum is not feasible.Clinical trial registration: The present study has been registered on clinicaltrials.gov (NCT04177407).

PMID:
42412373
Bibliographic data and abstract were imported from PubMed on 07 Jul 2026.

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