Song Yang, Yao Lu, Huan Peng, Shenying Luo, Jiawei Che, Darius Aw Kang Lie, Jian Zhang
MPO-based reconstruction after en bloc iliacoinguinal resection is feasible and appears safe in the short term. A stepwise approach that restores a groin anchor, re-establishes compartment separation, reinforces the abdominal wall, and manages femoral dead space may improve early junctional stability.
BACKGROUND: Anterior and lateral pelvic tumors may extend into the iliacoinguinal region and require wide en bloc resection. When resection includes the inguinal ligament, lower abdominal wall, and-in selected cases-the external iliac vessels, reconstruction must restore a mechanically demanding abdomen-groin junction while protecting major neurovascular structures. We describe an MPO-based reconstructive strategy and report early outcomes.
METHODS: We retrospectively reviewed six consecutive patients who underwent en bloc iliacoinguinal resection and reconstruction between January and December 2024. Reconstruction followed preperitoneal MPO repair principles, including a mesh-based inguinal ligament substitute, peritoneal envelope ("visceral sac") reconstruction when required, abdominal wall reinforcement, and femoral canal/oval fossa dead-space management. Prosthetic graft reconstruction was performed when the external iliac vessels were resected.
RESULTS: All patients completed the planned procedure. Inguinal ligament substitute reconstruction was performed in 6/6 patients, peritoneal envelope reconstruction in 5/6, and external iliac vessel resection with reconstruction in 4/6. Mean operative time was (375.83 ± 129.63) min and estimated blood loss was (433 ± 245.95) mL. Mean time to first flatus was (4 ± 0.89) days and length of stay was (8.67 ± 4.37) days. Pathology confirmed R0 resection in all cases. One patient developed an oval fossa seroma that resolved with repeated aspiration; two had transient mild lower-limb edema. No limb ischemia/necrosis, enteric fistula, bowel obstruction/ileus, or early abdominal wall hernia occurred during early follow-up.
CONCLUSIONS: MPO-based reconstruction after en bloc iliacoinguinal resection is feasible and appears safe in the short term. A stepwise approach that restores a groin anchor, re-establishes compartment separation, reinforces the abdominal wall, and manages femoral dead space may improve early junctional stability.