Perineal wound closure after extralevator abdominoperineal resection using biological mesh

Aims: This study aimed to describe the short-term perineal healing rates in patients with perineal reconstruction using a biological mesh following extralevator abdominoperineal excision (elAPE). Methods: In a retrospective, descriptive single-centre cohort study, 88 consecutive patients treated with elAPE and perineal closure using a biological mesh between January 2011 and December 2015 were reviewed. All available data from electronic hospital records was collected. Patients were followed for 1 year following surgery and perineal wound status assessed at 3 months and at 1 year. Results: In total, 63 patients were male and all but 8 patients were treated for primary rectal cancer. All patients but 3 had received radiotherapy prior to surgery. Multivisceral excisions were performed in 19 patients. Omentoplasty was performed in 55 patients and 3 different types of meshes were used during the study period. At 3 months, 58 patients (66%) had a healed perineum. No association was detected between patient, tumour or perioperative characteristics and perineal wound status at 3 months. At 1 year, 4 patients were deceased and among the remaining 84, the perineal wound was healed in 77 patients (92%). Conclusion: The use of biological meshes in perineal reconstruction following elAPE is feasible and safe, and the perineal wound is healed in the majority of the patients within 3 months.

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Outcomes following abdominoperineal resection 6 years retrospective study at a rural district general hospital

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20210862 ◽

2021 ◽

Vol 9 (3) ◽

pp. 665

Author(s):

Deeksha Arora ◽

Michael Tang ◽

Thomas Seddon ◽

Milind Rao

Keyword(s):

Retrospective Study ◽

Wound Closure ◽

Surgical Techniques ◽

Perineal Wound ◽

Biological Mesh ◽

Wound Complications ◽

Complication Rates ◽

Patient Factors ◽

Mesh Group ◽

Significant Difference

Background: A range of surgical techniques are used for perineal wound closure following Abdominoperineal Excision of the Rectum (APER). The aim of this study was to assess the safety and effectiveness of using a biological mesh for perineal wound closure and to compare the outcomes following conventional suture and mesh closure of the perineal wound.Methods: A single-centre retrospective study of a cohort of patients undergoing surgery for low rectal cancer between January 2013 and December 2018. Patient records were analysed for outcomes including perineal complication rates, length of hospital stay and impact of patient factors on complication rates in mesh vs no mesh group.Results: Of the total 43 patients included in the study, 13 (30%) had a conventional perineal closure whereas 30 patients (70%) had a biological mesh reconstruction. Early perineal wound complications were seen in 21/43 (49%) patients. Of those, 6 (29%) patients were in the no mesh group compared to 15 (71%) patients in the mesh group (p = 0.81). 84% of the patients who received neo adjuvant radiotherapy (NART) developed perineal wound infection. There was no statistically significant difference in the mesh and no mesh groups. None of the patient factors, other than preoperative anaemia, had a statistically significant association with the rate of complications in either of the groups.Conclusions: There was no statistically significant difference in the complication rate between primary and biological mesh closure. Biological mesh is safe for perineal reconstruction following APER.

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Perineal wound closure using gluteal turnover flap or primary closure after abdominoperineal resection for rectal cancer: study protocol of a randomised controlled multicentre trial (BIOPEX-2 study)

BMC Surgery ◽

10.1186/s12893-020-00823-7 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Sarah Sharabiany ◽

Robin D. Blok ◽

Oren Lapid ◽

Roel Hompes ◽

Wilhelmus A. Bemelman ◽

...

Keyword(s):

Rectal Cancer ◽

Abdominoperineal Resection ◽

Study Protocol ◽

Primary Closure ◽

Wound Closure ◽

Multicentre Trial ◽

Perineal Wound ◽

Cancer Study ◽

Randomised Controlled

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Primary Perineal Wound Closure After Preoperative Radiotherapy and Abdominoperineal Resection has a High Incidence of Wound Failure

Diseases of the Colon & Rectum ◽

10.1007/s10350-004-0827-1 ◽

2005 ◽

Vol 48 (3) ◽

pp. 438-443 ◽

Cited By ~ 250

Author(s):

Kelli M. Bullard ◽

Judith L. Trudel ◽

Nancy N. Baxter ◽

David A. Rothenberger

Keyword(s):

Abdominoperineal Resection ◽

Wound Closure ◽

Preoperative Radiotherapy ◽

Perineal Wound ◽

High Incidence ◽

Primary Perineal Wound Closure

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Pelvic reconstruction after extralevator abdominoperineal resection for rectal cancer: is there a place for a biological mesh in perineal wound complication?

Annals of Laparoscopic and Endoscopic Surgery ◽

10.21037/ales.2017.10.02 ◽

2017 ◽

Vol 2 ◽

pp. 156-156

Author(s):

Seung Yoon Yang ◽

Nam Kyu Kim

Keyword(s):

Rectal Cancer ◽

Abdominoperineal Resection ◽

Perineal Wound ◽

Wound Complication ◽

Biological Mesh ◽

Pelvic Reconstruction ◽

Perineal Wound Complication

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Randomised clinical trial for the cost–utility evaluation of two strategies of perineal reconstruction after abdominoperineal resection in the context of anorectal carcinoma: biological mesh repair versus primary perineal wound closure, study protocol for the GRECCAR 9 Study

BMJ Open ◽

10.1136/bmjopen-2020-043333 ◽

2021 ◽

Vol 11 (4) ◽

pp. e043333

Author(s):

Etienne Buscail ◽

Cindy Canivet ◽

Laurent Ghouti ◽

Sylvain Kirzin ◽

Nicolas Carrere ◽

...

Keyword(s):

Quality Of Life ◽

Abdominoperineal Resection ◽

Rectal Adenocarcinoma ◽

Perineal Wound ◽

Cost Utility ◽

Biological Mesh ◽

High Rate ◽

Sensitivity Analyses ◽

Ethical Review

IntroductionAbdominoperineal resections performed for anorectal tumours leave a large pelvic and perineal defect causing a high rate of morbidity of the perineal wound (40%–60%). Biological meshes offer possibilities for new standards of perineal wound reconstruction. Perineal fillings with biological mesh are expected to increase quality of life by reducing perineal morbidity.Methods and analysisThis is a multicentre, randomised and single-blinded study with a blinded endpoint evaluation, the experimental arm of which uses a biological mesh and the control arm of which is defined by the primary closure after abdominoperineal resection for cancer. Patients eligible for inclusion are patients with a proven history of rectal adenocarcinoma and anal canal epidermoid carcinoma for whom abdominoperineal resection was indicated after a multidisciplinary team discussion. All patients must have social security insurance or equivalent social protection. The main objective is to assess the incremental cost–utility ratio (ICUR) of two strategies of perineal closure after an abdominoperineal resection performed for anorectal cancer treatment: perineal filling with biological mesh versus primary perineal closure (70 patient in each arm). The secondary objectives focus on quality of life and morbidity data during a 1-year follow-up. Deterministic and probabilistic sensitivity analyses will be performed in order to estimate the uncertainty surrounding the ICUR. CIs will be constructed using the non-parametric bootstrap approach. A cost-effectiveness acceptability curve will be built so as to estimate the probability of efficiency of the biological meshes given a collective willingness-to-pay threshold.Ethics and disseminationThe study was approved by the Regional Ethical Review Board of ‘Nord Ouest 1’ (protocol reference number: 20.05.14.60714; national number: 2020-A01169-30).The results will be disseminated through conventional scientific channels.Trial registration numberClinicalTrials.gov Registry (NCT02841293).

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