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Pelvic Reconstruction Surgery

What is Pelvic Reconstruction Surgery?

Pelvic reconstruction surgery is a group of surgical procedures performed to restore the structure and function of the pelvis following the removal of cancer or extensive pelvic surgery. It is commonly undertaken after complex operations such as radical cystectomy, pelvic exenteration, or surgery for advanced bladder, prostate, colorectal, or gynaecological cancers.

The aim of reconstruction is to rebuild affected tissues, restore urinary or bowel function where possible, protect vital organs, and improve quality of life. Depending on the patient's needs, reconstruction may involve the use of muscle, skin, or other tissue flaps, urinary diversion, bowel reconstruction, or repair of the pelvic floor.

What are the Benefits of Pelvic Reconstruction Surgery?

Pelvic reconstruction can help patients recover both physically and functionally following major pelvic surgery.

Benefits include:

  • Restoration of pelvic anatomy after cancer surgery
  • Protection and support of pelvic organs
  • Improved wound healing
  • Reduced risk of complications such as wound breakdown
  • Reconstruction of urinary or bowel function when appropriate
  • Improved mobility and comfort during recovery
  • Enhanced quality of life following extensive pelvic surgery
  • Individualised treatment tailored to each patient's condition

When is Pelvic Reconstruction Surgery Recommended?

Pelvic reconstruction is recommended when major pelvic surgery leaves a significant tissue or functional defect that requires repair.

It may be advised for:

  • Reconstruction following radical cystectomy
  • Surgery after pelvic exenteration
  • Advanced bladder or prostate cancer surgery
  • Large pelvic defects following tumour removal
  • Complex pelvic wounds requiring tissue coverage
  • Repair of pelvic floor defects
  • Patients requiring urinary or bowel reconstruction
  • Selected cases involving recurrent pelvic cancer surgery

The decision is usually made by a multidisciplinary team including urological, colorectal, plastic, and reconstructive surgeons.

What does Preparation for Pelvic Reconstruction Surgery Involve?

Preparation begins with a detailed assessment to determine the extent of reconstruction required.

This may include:

  • CT or MRI scans to assess pelvic anatomy
  • Blood tests and general medical assessment
  • Nutritional optimisation before surgery
  • Review of medications, particularly anticoagulants
  • Consultation with reconstructive and plastic surgeons where appropriate
  • Stoma education if urinary or bowel diversion is anticipated
  • Discussion of expected recovery and long-term outcomes

Patients are also assessed to ensure they are fit enough to undergo what is often a lengthy surgical procedure.

How is Pelvic Reconstruction Surgery Performed?

Pelvic reconstruction is performed under general anaesthetic and is usually carried out immediately after the cancer has been removed.

The reconstructive technique depends on the type of surgery performed and the structures requiring repair. If a large tissue defect remains after tumour removal, healthy muscle, skin, or fatty tissue may be transferred from another part of the body to fill the space and promote healing. Commonly used tissue flaps include those taken from the abdomen, thigh, or buttock.

When the bladder has been removed, reconstruction may involve creating a urinary diversion using a section of the small intestine. This may be an ileal conduit, a continent urinary reservoir, or, in selected patients, an orthotopic neobladder that allows urine to pass through the urethra.

If bowel surgery has also been performed, reconstruction may involve reconnecting the bowel or creating a temporary or permanent stoma. Throughout the operation, the surgical team works to restore pelvic stability, minimise complications, and optimise long-term function while ensuring complete cancer treatment has been achieved.

What to Expect during Recovery after Pelvic Reconstruction Surgery?

Recovery varies depending on the extent of both the cancer surgery and the reconstruction.

Most patients remain in hospital for several days to two weeks while healing begins. During this time, the healthcare team monitors wound healing, urinary and bowel function, nutrition, pain control, and mobility.

During recovery, patients can expect:

  • Gradual return to eating and drinking
  • Physiotherapy to improve strength and mobility
  • Education on caring for urinary diversions or stomas if required
  • Regular wound assessments
  • Follow-up imaging and outpatient reviews
  • Recovery over several weeks to several months depending on the complexity of surgery

Ongoing rehabilitation and specialist nursing support are often important components of long-term recovery.

What are the Risks and Complications of Pelvic Reconstruction Surgery?

As with any major operation, pelvic reconstruction surgery carries potential risks.

Possible complications include:

  • Bleeding
  • Infection
  • Wound healing problems
  • Tissue flap failure, although uncommon
  • Urinary leakage or bowel leakage
  • Blood clots
  • Hernia formation
  • Stoma-related complications where applicable
  • Changes in urinary, bowel, or sexual function
  • Need for additional reconstructive procedures if complications occur

Your specialist surgical team will discuss the most appropriate reconstructive options for your individual situation, along with the expected benefits, potential risks, and recovery process before surgery.