Dynamic MRI to assess pelvic floor reconstruction with Strattice™mesh after extralevator abdominoperineal excision for rectal cancer - a video vignette

2016 ◽  
Vol 18 (3) ◽  
pp. 313-314
Author(s):  
M. I. Aslam ◽  
I. Mykoniatis ◽  
C. Mann ◽  
J. A. Stephenson ◽  
R. Verma ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Pelvic Floor ◽  
Dynamic Mri ◽  
Abdominoperineal Excision ◽  
Pelvic Floor Reconstruction ◽  
Video Vignette

Pelvic floor reconstruction with bilateral gracilis flaps following extralevator abdominoperineal excision - a video vignette

2017 ◽  
Vol 19 (12) ◽  
pp. 1120-1121 ◽  
Author(s):  
C. S. Jones ◽  
J. Nowers ◽  
N. J. Smart ◽  
J. Coelho ◽  
A. Watts ◽  
...  
Keyword(s):  
Pelvic Floor ◽  
Abdominoperineal Excision ◽  
Pelvic Floor Reconstruction ◽  
Video Vignette

scholarly journals Extralevator abdominoperineal excision for rectal cancer with biological mesh for pelvic floor reconstruction

Oncotarget ◽  
2016 ◽  
Vol 8 (5) ◽  
pp. 8818-8824 ◽  
Author(s):  
Wei Ge ◽  
Song-song Jiang ◽  
Wang Qi ◽  
Hao Chen ◽  
Li-ming Zheng ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Pelvic Floor ◽  
Abdominoperineal Excision ◽  
Biological Mesh ◽  
Pelvic Floor Reconstruction

scholarly journals Dynamic Magnetic Resonance Imaging Demonstrates the Integrity of Perineal Reconstruction following Cylindrical Abdominoperineal Excision with Reconstruction of the Pelvic Floor Using Porcine Collagen

2012 ◽  
Vol 2012 ◽  
pp. 1-5 ◽  
Author(s):  
D. O. Kavanagh ◽  
H. Imran ◽  
A. Almoudaris ◽  
P. Ziprin ◽  
O. Faiz
Keyword(s):  
Pelvic Floor ◽  
Clinical Evidence ◽  
Digital Rectal Examination ◽  
Dynamic Mri ◽  
Posterior Wall ◽  
Abdominoperineal Excision ◽  
Perineal Hernia ◽  
En Bloc ◽  
Rectal Pain ◽  
Radiological Staging

A 72-year-old female presented with a six-month history of increased frequency of defecation, rectal bleeding, and severe rectal pain. Digital rectal examination and endoscopy revealed a low rectal lesion lying anteriorly. This was confirmed histologically as adenocarcinoma. Radiological staging was consistent with a T3N2rectal tumour. Following long-course chemoradiotherapy repeat staging did not identify any metastatic disease. She underwent a laparoscopic cylindrical abdominoperineal excision withen blocresection of the coccyx and posterior wall of the vagina with a negative circumferential resection margin. The perineal defect was reconstructed with Permacol (biological implant, Covidien) mesh. She had no clinical evidence of a perineal hernia at serial followup. Dynamic MRI images of the pelvic floor obtained during valsalva at 10 months revealed an intact pelvic floor. A control case that had undergone a conventional abdominoperineal excision with primary perineal closure without clinical evidence of herniation was also imaged. This confirmed subclinical perineal herniation with significant downward migration of the bowel and bladder below the pubococcygeal line. We eagerly await further evidence supporting a role for dynamic MR imaging in assessing the integrity of a reconstructed pelvic floor following cylindrical abdominoperineal excision.

scholarly journals The results of use of myoplasty for closure of the pelvic floor defect after extralevator abdominoperineal excision of the rectum

2019 ◽  
Vol 17 (6) ◽  
pp. 35-40
Author(s):  
N. A. Domansky ◽  
V. V. Semiglazov ◽  
A. M. Karachun ◽  
K. K. Lebedev ◽  
D. V. Samsonov ◽  
...  
Keyword(s):  
Pelvic Floor ◽  
Perineal Wound ◽  
Abdominoperineal Excision ◽  
Early Postoperative Period ◽  
Wound Complications ◽  
Pelvic Floor Reconstruction ◽  
Group Iii ◽  
Group I ◽  
Perineal Wound Complications ◽  
Group Ii

Background. Extralevator abdominoperineal excision is associated with a high incidence of perineal wound complications. There is no uniform standard for choosing the method for pelvic floor reconstruction after extralevator abdominoperineal excision.The purpose of the study was to compare the results of extralevator abdominoperineal excisions of the rectum using various methods of perineal wound closure.Materials and Methods. Between 2014 and 2018, 120 patients underwent extralevator abdominoperineal excisions of the rectum using various options for closure of the pelvic floor. The patients were divided into 3 groups. Group I patients (n=64) underwent simple plasty of the peritoneal wound. Group II patients (n=43) underwent myoplasty using the gluteus maximus muscle. Group III patients (n=13) underwent myoplasty using the rectus abdominis muscle. The incidence of perineal wound complications in the early postoperative period was assessed.Results. The total number of perineal wound complications in Group I, II and III was 33 (51.5 %), 13 (30.2 %), and 6 (46.1 %), respectively. Grade IIIA-IIIB complications according to the Clavien-Dindo classification were observed in 25 % of Group I patients, in 18.6 % of Group II patients and in 7.7 % of Group II patients. Postoperative perineal wound complications occurred more often in Group I patients after simple plasty than in Group II and III patients after myoplasty (51.5 % versus 30.2 %). However, perineal wound complications were observed more often in Group III than in Group II (46.1 % versus 30.2 %, respectively). No significant differences in the frequency of complications between 3 groups were found.Conclusion. Using various options for closure of the pelvic floor after extralevator abdominoperineal excisions of the rectum, there was a tendency to reduction in the incidence of grade IIIA-IIIB perineal wound complications.

scholarly journals Multicentre, randomised trial comparing acellular porcine collagen implant versus gluteus maximus myocutaneous flap for reconstruction of the pelvic floor after extended abdominoperineal excision of rectum: study protocol for the Nordic Extended Abdominoperineal Excision (NEAPE) study

BMJ Open ◽  
2019 ◽  
Vol 9 (5) ◽  
pp. e027255 ◽  
Author(s):  
Martin Rutegård ◽  
Jörgen Rutegård ◽  
Markku M Haapamäki
Keyword(s):  
Rectal Cancer ◽  
Pelvic Floor ◽  
Myocutaneous Flap ◽  
Gluteus Maximus ◽  
Abdominoperineal Excision ◽  
Ethical Review ◽  
Reconstruction Method ◽  
Collagen Implant ◽  
Porcine Collagen ◽  
Gluteus Maximus Myocutaneous Flap

IntroductionDifferent surgical techniques are used to cover the defect in the floor of the lesser pelvis after an ‘extralevator’ or ‘extended’ abdominoperineal excision for advanced rectal cancer. However, these operations are potentially mutilating, and the reconstruction method of the pelvic floor has been studied only sparsely. We aim to study whether a porcine-collagen implant is superior or equally beneficial to a gluteus maximus myocutaneous flap as a reconstruction method.Methods and analysisThis is a multicentre non-blinded randomised controlled trial with the experimental arm using a porcine-collagen implant and the control arm using a gluteus maximus muscle and skin rotation flap. Considered for inclusion are patients with rectal cancer, who are operated on with a wide abdominoperineal rectal excision including most of the levator muscles and where the muscle remnants cannot be closed in the midline with sutures. Patients with a primary or recurrent rectal cancer with an estimated survival of more than a year are eligible. The randomisation is computer generated with a concealed sequence and stratified by participating hospital and preoperative radiotherapy regimen. The main outcome is physical performance 6 months after surgery measured with the timed-stands test. Secondary outcomes are perineal wound healing, surgical complications, quality of life, ability to sit and other outcomes measured at 3, 6 and 12 months after surgery. To be able to state experimental arm non-inferiority with a 10% margin of the primary outcome with 90% statistical power and assuming 10% attrition, we aim to enrol 85 patients from May 2011 onwards.Ethics and disseminationThe study has been approved by the Regional Ethical Review board at Umeå University (protocol no: NEAPE-2010-335-31M). The results will be disseminated through patient associations and conventional scientific channels.Trial registration numberNCT01347697; Pre-results.

Reconstruction of the pelvic floor with Hem-o-lok clips in laparoscopic abdominoperineal excision of rectal cancer

2016 ◽  
Vol 31 (8) ◽  
pp. 1539-1540 ◽  
Author(s):  
Xiaowen Xu ◽  
Jie Yuan ◽  
Zhuqing Zhou ◽  
Junjie Xing ◽  
Chuangang Fu
Keyword(s):  
Rectal Cancer ◽  
Pelvic Floor ◽  
Abdominoperineal Excision

Laparoscopic extralevator abdominoperineal excision for low rectal cancer - a video vignette

2016 ◽  
Vol 18 (3) ◽  
pp. 315-316
Author(s):  
Z. S. Xie ◽  
H. S. Zhang ◽  
X. F. Cui
Keyword(s):  
Rectal Cancer ◽  
Abdominoperineal Excision ◽  
Low Rectal Cancer ◽  
Video Vignette
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