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Peritonectomy: what stripping the lining of the abdomen involves | CION Cancer Clinics
A peritonectomy is an operation that strips away the peritoneum, the thin lining that covers the inside of the abdomen and its organs, from the regions where cancer has settled on it. It is the main surgical part of the treatment that usually ends with heated chemotherapy in the abdomen. This page explains which regions are stripped, what happens in theatre, and what living without part of the lining means. CION Cancer Clinics’ surgical oncologists in Hyderabad can talk this through with you.
MI
Medically reviewed by Dr. Mohammed ImaduddinConsultant Surgical Oncologist · MBBS, MS (General Surgery), MCh (Surgical Oncology) · last reviewed September 2026, next review due September 2027
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The short answer
What is a peritonectomy?
A peritonectomy is an operation that strips away the peritoneum, the thin, smooth lining that covers the inside wall of the abdomen and the organs within it, from the areas where cancer has settled on it. It is the main surgical part of cytoreduction, the operation done before heated chemotherapy is put into the abdomen.
Why the lining is removed rather than the cancer picked off
Cancer that spreads to the peritoneum sits on the lining as many small deposits, some too small to see. Picking off each one would leave the rest behind. Stripping the whole sheet of lining from an affected region removes the visible deposits and the surface around them in one piece.
Not the whole lining, only the affected parts
The abdomen is divided into regions, and the surgeon strips only the regions where disease is found. Someone with cancer in the pelvis and under the right side of the diaphragm will have those two regions stripped and the rest left alone. Healthy lining is not removed for the sake of it.
Peritonectomy and HIPEC are not the same thing. The first is the surgery. The second is the heated chemotherapy wash that usually follows it in the same operation.The regions
Which parts of the lining can be stripped?
Surgeons describe the operation by region. Your consent form or operation note may list several of these.
The pelvis
The lining of the lowest part of the abdomen, around the bladder, rectum and, in women, the womb and ovaries. Disease often collects here because fluid settles at the bottom. The womb and ovaries are sometimes removed with it.
Under the right diaphragm
The lining on the underside of the breathing muscle, above the liver. Fluid moves upwards here as you breathe, carrying cancer cells with it, so this is one of the commonest regions to be stripped.
Under the left diaphragm
The same surface on the left, above the spleen and stomach. Because the spleen sits so close, it is sometimes removed along with the lining in this region.
The omentum
A fatty apron that hangs from the stomach over the bowel. It is not strictly lining, but it collects cancer cells so reliably that it is removed in almost every one of these operations.
The front wall and the flanks
The lining of the front and sides of the abdominal wall, behind the muscles. It is stripped as a sheet where deposits sit, sometimes through the whole length of the cut.
Not sure whether this applies to you?
Ask an oncologistInside the theatre
What actually happens during a peritonectomy?
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Opening and looking
A long cut is made down the middle of the abdomen. The surgeon first looks everywhere and scores how much disease there is, region by region. If there is far more than the scans showed, the operation may stop here.
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Freeing old scar tissue
If you have had surgery before, organs may be stuck together. These are separated carefully so that every surface can be seen.
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Stripping the lining, region by region
The surgeon lifts the lining away from the muscle or organ beneath, using an electrical instrument that cuts and seals at the same time. This is slow, careful work, and it is where most of the hours go.
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Removing organs where needed
Where cancer has grown into an organ rather than sitting on it, a part of that organ is removed. The bowel, spleen, gallbladder, womb and ovaries are the usual ones.
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The heated chemotherapy
With the abdomen cleared, warmed chemotherapy is circulated through it to reach cells too small to see. Then it is drained out.
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Joining, draining and closing
Any bowel that was cut is joined back together, or a stoma is made. Drains are placed and the abdomen is closed.
Afterwards
What does living without part of the lining mean?
Less than people fear. The stripped surfaces heal over with a new layer of cells within weeks, and the body does not miss the lining once it has. The organs beneath keep working. What you notice afterwards comes from the size of the operation, not from the missing lining.
Fluid and drains
Raw surfaces weep fluid while they heal, so drains stay in for longer than after most operations. The amount falls day by day and the drains come out when it is low enough. This is expected, not a complication.
Adhesions later on
Healed surfaces can stick to each other, forming bands of scar called adhesions. Most people never notice them. In a few, they cause bouts of cramping pain or, rarely, a blocked bowel years later. That is why you are told to report severe belly pain with vomiting promptly, even long after the operation.
What this page cannot tell you
It cannot tell you which regions your own surgeon will need to strip, or which organs will need to be removed. That is only known once the abdomen is open. Ask your surgeon what they expect from the scans, and what they will do if they find more.
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Commonly believed
Four things families ask about stripping the lining
"Without the lining, the organs will be unprotected."
The lining is a thin, slippery sheet, not armour. Its job is to let organs slide against each other, and the body grows a new surface layer over stripped areas within weeks. The organs are not left exposed.
"If the cancer lives on the lining, removing all of it removes the cancer."
The surgeon removes the lining where disease sits and every visible deposit. Cells too small to see may remain, which is why the heated chemotherapy follows. It lowers the chance of the cancer returning; it does not promise that it will not.
"Stripping the lining is a small part of the operation."
It is most of it. Region by region, the lining is lifted away in slow, careful work, and this is where the hours in theatre go. The heated chemotherapy at the end takes a fraction of the time.
"Peritonectomy is just another word for HIPEC."
They are two halves of one treatment. Peritonectomy is the surgery that removes the lining and visible cancer. HIPEC is the heated chemotherapy wash that usually follows. One can, in some situations, be done without the other.
Before you sign
What to ask your surgeon about the operation
- Which regions of the lining do you expect to strip, based on my scans?
- Which organs might need to be removed, and will I know before I wake up?
- What will you do if you find more disease than expected?
- Is a stoma possible, and would it be temporary or permanent?
- How many of these operations does this team do each year?
- Who do I call if I have severe belly pain months from now?
Did you know
The surgical instrument used to strip the lining cuts and seals at the same time, which is why bleeding from such a large raw surface can be controlled. The technique was developed in the 1990s and is still the basis of the operation today.
Questions we are asked
Common questions about peritonectomy
Does the lining grow back?
A new surface layer forms over the stripped areas within a few weeks, and the body functions normally without the original sheet. The organs do not need the lining to work. What can form as the surfaces heal is scar tissue, which is why some people have bouts of cramping pain later on.
Is it done by keyhole surgery?
Almost never. The surgeon needs to see and reach every surface of the abdomen, and to strip large sheets of lining, so a long open cut is used. A keyhole look may be done beforehand to decide whether the full operation is worthwhile, but that is a separate, much smaller procedure.
Will I have a stoma afterwards?
Possibly, if a section of bowel is removed and the surgeon judges that a join would not heal safely. Many stomas made during this operation are temporary and reversed later. Ask before the operation how likely a stoma is in your case, and whether it would be planned as temporary.
Why is the operation so long?
Because the lining is lifted away slowly, region by region, from surfaces that bleed easily, and because any organ removals and bowel joins are done in the same operation. Then the heated chemotherapy is circulated and drained. Each step is careful rather than fast, and there is no shortcut through it.
Can only the pelvis be stripped, or is it always everything?
Only the regions with disease are stripped. Someone with cancer confined to the pelvis has a much smaller operation than someone with disease under both sides of the diaphragm. The scans give the surgeon a plan, and what they see once the abdomen is open settles it.
Will the scar be large?
Yes. The cut usually runs from below the breastbone to just above the pubic bone, because the surgeon must reach every region. It fades over a year or so. Ask about wound care and when you can lift, bend and bathe normally, because those rules matter more than the length of the scar.
Is stripping the diaphragm dangerous for breathing?
The lining is lifted off the muscle, and the muscle itself is kept unless cancer has grown into it. Where a small piece of diaphragm has to be removed, it is repaired in the same operation. Breathing is shallow for a few days from the pain and the size of the cut, which is why breathing exercises start early.
Is the operation covered by Aarogyasri or insurance?
Cover varies by scheme and by how the operation is coded, so it is worth checking before you travel rather than after. Aarogyasri, CGHS, ECHS and EHS are accepted, and most cashless insurers are empanelled. Call the helpline with your card details and we will check what applies to you.
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Sources
- NICE — Cytoreduction surgery followed by hyperthermic intraoperative peritoneal chemotherapy for peritoneal carcinomatosis (IPG331)
- Cancer Research UK — Pseudomyxoma peritonei
- National Cancer Institute — HIPEC (NCI Dictionary of Cancer Terms)
- Macmillan Cancer Support — Surgery for cancer
This page is general information, not a prescription. Do not change or stop any treatment based on what you read here. If anything is worrying you, contact your own treating team — or call our helpline and we will help you reach the right specialist.
Keep reading
Related pages
Cytoreductive Surgery Plus HIPEC: The Two HalvesHow the surgery and the chemotherapy fit togetherOrgans That May Be Removed During CytoreductionWhat happens when cancer has grown into an organHow Long Does HIPEC Surgery Take?Where the hours in theatre goDrains, Tubes, Lines and CathetersWhy drains stay in longer after this operationHIPEC and Peritoneal Surface SurgeryEvery page in this guide
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