V08-10: How does the Bladder Heal after Peritoneal Advancement Flaps? Insights from a Reoperative Case
Symptomatic pelvic lymphoceles occur in 4 to 15% of patients undergoing robotic-assisted laparoscopic prostatectomy (RALP) with pelvic lymph node dissection (PLND). We previously describe a peritoneal advancement flap technique by interposing the lateral peritoneum between the bladder and lymphadenectomy bed, preventing the bladder from walling off a cavity. We offer an update to our series and a unique reoperative look into a healed pelvis years after this technique.
Previously, we had retrospectively evaluated 155 patients undergoing RALP with PLND over a course of 2 years from a two surgeon, single-institution series. They were separated into two groups: those who underwent RALP with PLND without peritoneal advancement flaps (Group A) and those who underwent RALP with PLND and peritoneal advancement flaps (Group B). Symptomatic lymphoceles were confirmed by cross sectional imaging. In this interim analysis, we added 48 patients undergoing RALP with PLND over one additional year. In one patient who underwent a laparoscopic cholecystectomy post-operatively, visual evaluation of how the bladder healed 2 years after his RALP with PLND is described.
Total pooled data included 199 patients who underwent RALP and PLND over 3 years. Both patient groups were similar in terms of age, pre-operative PSA, BMI, biopsied Gleason Score and post-prostatectomy pathologic stage and peri-operative heparin use. Group A without the peritoneal advancement flap (90 patients) had 9 symptomatic lymphoceles (9.0%) Group B undergoing the peritoneal advancement flap (109 patients) had no symptomatic lymphoceles. (p
In our experience, performing peritoneal advancement flaps during RALP with PLND is an effective and durable technique to prevent symptomatic pelvic lymphocele formation. We demonstrated a proof of concept case, in which guided bladder healing created a final anatomic configuration exactly as we had hoped. This rare reoperative perspective after prolonged healing may help communicate the utility of our technique.