Application of modified primary closure of the pelvic floor in laparoscopic extralevator abdominal perineal excision for low rectal cancer

Figure 1 Surgical procedures. A: Port placement; B: Transection of the rectum at the rectosigmoid junction with an ENDO-GIA; C: Distal rectum pushed down to the pelvis; D: Closure of the pelvic peritoneum with a continuous suture using a barbed thread; E: Closure of the pelvic peritoneum; F: Tension reduction of the adjacent peritoneum (the dotted line shows the incised peritoneum); G: Closure of the peritoneum after tension reduction (the dotted line shows the incised peritoneum); H: Reconstruction of the pelvic floor with biological mesh; I: View of the closed peritoneum from the perineal wound in the prone position (the arrows show the presacral veins, and the arrowheads show the closed peritoneum).

Figure 2 Drainage and temperature changes. A: Postoperative drainage volumes in the two groups; B: Postoperative temperature changes in the two groups.

Figure 3 Laparoscopy. Laparoscopic exploration of the abdominal cavity in the patient with intestinal obstruction (the arrow shows the proximal dilated small intestine, and the arrowhead shows the distal normal small intestine).

Figure 4 Postoperative magnetic resonance imaging. A: Twelve-month postoperative Sagittal CT scan in the modified primary closure group; B: Twelve-month postoperative Sagittal CT scan in the biological mesh closure group; C: Twelve-month postoperative Coronal CT scan in the modified primary closure group; D: Twelve-month postoperative Coronal CT scan in the biological mesh closure group (the arrow shows the small intestine, and the arrowhead shows the bladder). CT: Computed tomography.