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01-12-2009 | The Last Image
Sugarbaker procedure for Pseudomyxoma Peritonei
Published in: Techniques in Coloproctology | Issue 4/2009
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Pseudomyxoma Peritonei (PMP) is an uncommon condition characterised by diffuse mucinous ascites or “jelly belly”, and multifocal peritoneal implants. PMP commonly arises from an occult epithelial malignancy of the appendix. Surgical treatment involves a series of peritonectomy procedures and visceral resections to achieve macroscopic tumour clearance followed by heated intraperitoneal chemotherapy as described by Sugarbaker (Figs. 1, 2, 3, 4, 5, 6, 7, 8, 9).
Fig. 1
Preoperative cross-sectional imaging showing diffuse intraperitoneal involvement with mucinous ascites
Fig. 2
Immediate findings at laparotomy showing “jelly belly” appearances
Fig. 3
Perforated primary appendiceal tumour
Fig. 4
Right parietal peritonectomy
Fig. 5
Stomach reflected upwards after greater and lesser omentectomy and splenectomy with left gastric artery preserved
Fig. 6
Pelvic peritonectomy and anterior resection with bladder stripped of peritoneum and retracted forward
Fig. 7
Liver capsulectomy with high power diathermy, and cholecystectomy
Fig. 8
Heated intraoperative peritoneal chemotherapy with mitomycin C at 41°C by coliseum technique
Fig. 9
Flat abdomen following complete cytoreduction with tube drains for postoperative intraperitoneal chemotherapy with 5-fluorouracil
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