A low incidence of perineal hernia when using a biological mesh after extralevator abdominoperineal excision with or without pelvic exenteration or distal sacral resection in locally advanced rectal cancer patients

Esmée Dijkstra, N. L. E. Kahmann, Patrick Hemmer, Klaas Havenga, Boudewijn Etten, van*

*Corresponding author for this work

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    Abstract

    Background Extralevator abdominoperineal excision (ELAPE), abdominoperineal excision (APE) or pelvic exenteration
    (PE) with or without sacral resection (SR) for locally advanced rectal cancer leaves a significant defect in the pelvic floor.
    At first, this defect was closed primarily. To prevent perineal hernias, the use of a biological mesh to restore the pelvic floor
    has been increasing. The aim of this study, was to evaluate the outcome of the use of a biological mesh after ELAPE, APE
    or PE with/without SR.
    Methods A retrospective study was conducted on patients who had ELAPE, APE or PE with/without SR with a biological
    mesh (Permacol™) for pelvic reconstruction in rectal cancer in our center between January 2012 and April 2015. The
    endpoints were the incidence of perineal herniation and wound healing complications.
    Results Data of 35 consecutive patients [22 men, 13 women; mean age 62 years (range 31–77 years)] were reviewed. Median
    follow-up was 24 months (range 0.4–64 months). Perineal hernia was reported in 3 patients (8.6%), and was asymptomatic
    in 2 of them. The perineal wound healed within 3 months in 37.1% (n = 13), within 6 months in 51.4% (n = 18) and within
    1 year in 62.9% (n = 22). In 17.1% (n = 6), the wound healed after 1 year. It was not possible to confirm perineal wound
    healing in the remaining 7 patients (20.0%) due to death or loss to follow-up. Wound dehiscence was reported in 18 patients
    (51.4%), 9 of whom needed vacuum-assisted closure therapy, surgical closure or a flap reconstruction.
    Conclusions Closure of the perineal wound after (EL)APE with a biological mesh is associated with a low incidence of
    perineal hernia. Wound healing complications in this high-risk group of patients are comparable to those reported in the
    literature.
    Original languageEnglish
    Pages (from-to)855-861
    Number of pages7
    JournalTechniques in Coloproctology
    Volume24
    Issue number8
    DOIs
    Publication statusPublished - 8-Jun-2020

    Keywords

    • Biological mesh
    • Permacol
    • Perineal hernia
    • Wound healing
    • Rectal cancer surgery
    • Extralevator abdomino perineal excision
    • Pelvic exenteration

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