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

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).