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Total Pelvic Exenteration: Procedure and Risks

written by: R. Elizabeth C. Kitchen • edited by: Leigh A. Zaykoski • updated: 7/21/2010

If you are getting ready to have a total pelvic exenteration surgery, it will help to learn more about this surgery, how it is performed, and the possible risks that you face after the surgery. To learn more about these, read on.

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    A total pelvic exenteration is a surgery in which all of the pelvic organs are removed and is the most extensive pelvic surgery. This surgery is most often performed when cervical cancer has recurred in the pelvic cavity after radiation therapy or surgery. This surgery is life and body changing, but most patients will lead a full life after the surgery, but this will take time, and in most cases, additional reconstructive surgeries.

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    How is this Surgery Performed?

    Patients will be put to sleep under general anesthesia for this procedure. Once they are completely asleep, the surgeon will begin by making an incision in their lower abdominal area and clamping off all necessary blood vessels. Then the surgeon will remove all pelvic organs, including:

    • Uterus
    • Ovaries
    • Vagina
    • Urethra
    • Cervix
    • Fallopian tubes
    • Bladder
    • Rectum

    Once these organs are removed, two ostomies will be created. The surgeon will create an ostomy for urine and an ostomy for stool. The vagina is rebuilt in most cases. This can be done during this surgery, but is most often done as a separate surgery once a patient recovers from a total pelvic exenteration.

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    Possible Risks and Complications

    According to the Encyclopedia of Surgery, as many as 30 to 44 percent of patients can experience complications during this operation. The mortality rate is about three to five percent. Patients who have this operation have a 23 to 61 percent five-year survival rate.

    The possible complications of this surgery can include:

    • Anesthesia complications
    • Injury to adjacent structures or organs
    • Wound infection
    • Bowel injury
    • Urinary retention making it a requirement to permanently use a urinary catheter
    • Hemorrhaging requiring a blood transfusion
    • Urinary tract infection
    • Bowel obstruction
    • Fistula formation
    • Kidney failure
    • Kindey inflammation
    • Ureter narrowing
    • Pulmonary embolism (blood clot that goes to the lungs)
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    Recovering from a Total Pelvic Exenteration

    Recovery is a lengthy process with this surgery. It takes about a full six months for most women to feel that they are completely healed. According to the American Cancer Society, some women say that it takes at least a year or two before they completely adjust to the body changes this surgery causes.

    Right after the surgery, the patient will stay in the hospital for pain management and monitoring for three to five days. The side effects of this surgery can include:

    • Some discharge and bleeding
    • Moderate tenderness
    • Difficulty urinating
    • Moderate to significant lower abdominal pain

    The patient's stitches will most often be removed before they are sent home. They will receive prescription pain medication with full instructions on how to take it when they are discharged from the hospital.

    Activities are severely limited for at least six to eight weeks. Patients should get up and walk around when they are able, but should not walk for long and should not go up stairs until their doctor tells them they can. Patients should not bend or lift and must abstain from sexual intercourse until their doctor tells them they can resume these activities.

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    Resources

    American Cancer Society. (2010). Total Pelvic Exenteration. Retrieved on July 15, 2010 from the American Cancer Society: http://www.cancer.org/Treatment/TreatmentsandSideEffects/PhysicalSideEffects/SexualSideEffectsinWomen/SexualityfortheWoman/sexuality-for-women-with-cancer-tot-pelvic-exenterat

    Encyclopedia of Surgery. (2010). Exenteration. Retrieved on July 15, 2010 from the Encyclopedia of Surgery: http://www.surgeryencyclopedia.com/Ce-Fi/Exenteration.html