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