3 | Discussion
An estimated 570 000 cases of cervical cancer were diagnosed in 2018, and 311 000 women died from this malignancy. Cervical cancer is the most common cause of cancer-related death among women in 42 countries especially underdeveloped and developing countries although it has been comparatively well controlled in many developed countries [1].
For patients who are affected by advanced primary or recurrent pelvic malignancies, the only procedure with the possibility of cure is surgical intervention. A pelvic exenteration (or pelvic evisceration) is an ultra-radical operative procedure characterized by the en bloc resection of the pelvic organs for patients with advanced primary or recurrent pelvic neoplasms. A complete PE is a treatment that removes all organs from a person’s pelvic cavity. The distal sigmoid colon, rectum, and anus along with the urinary bladder, urethra, and genital organs are resected. In women, the vagina, cervix, uterus, fallopian tubes, ovaries, and, in some cases, the vulva are also removed (Fig.1) [2].
Whereas PE is an aggressive operative procedure that left a large dead space, it is necessary to fill that pelvic defect. This procedure is called pelvic reconstruction [3].
One of the most common types of PR is a soft-tissue reconstruction of the pelvis with vascularized tissue flaps. The best type of flaps is performed to transfer tissue from a donor site to a recipient site to efface dead space, return function and figure, provide structural support for the pelvic viscera, and guarantee proper wound healing and closure. The vertical rectus abdominis myocutaneous flap (VRAM) and the omental pedicle flap are the most commonly used pedicle flaps in tandem for pelvic reconstruction following these oncologic interventions [4].
We placed an omental pedicle flap used to fill the pelvic dead space and bakri balloon catheter used for closure of perineal and vaginal defects. The Bakri balloon is a silicone balloon designed for the treatment of uterine bleeding in postpartum hemorrhage (Fig.2). In our patient VRAM flap is not a perfect choice because of many reasons such as recent radiation, non-bulking VRAM, past surgery in that area, etc. Instead of this bakri balloon catheter was placed to support the omental pedicle flap and prevent it from visceral pressure and rupture and ischemia. Moreover, it gives time to create a granulation tissue and fill dead space to prevent visceral prolapse. We would like to empty the balloon gradually, but we had to remove it almost 20 days after surgery. because despite its benefits bakri balloon as a foreign body has a high chance to infect and forming a biofilm. On the other hand, because of pelvic manipulation, the probability of fasciitis and clostridium contamination is high, so the infection management was hard.
It recommends studying more about drains containing an antimicrobial coating.
This method has a bright future for pelvic reconstruction without muscular flaps and prevents prolapsing.
Figure 1
Figure 2