Laparoscopic extralevator abdominoperineal resection with perineal reconstruction with gluteal flap (clinical case)

AIM: to demonstrate the first experience of extralevator abdominoperineal resection (ELAPR) with gluteoplasty.PATIENTS AND METHODS: patient K., aged 71 years old, with a low rectal cancer cT3aN0M1a CRM– EMVI+ (IV st) after neoadjuvant chemoradiation therapy, underwent surgery. Laparoscopic extralevator abdominoperineal resection with gluteoplasty was performed.RESULTS: the patient was mobilized on the next day after surgery, the drain tubes were removed on the 5th day. On the 7th day, the seroma of the perineal wound without signs of suppuration was drained. No discomfort or movement disorders were noted. The patient was discharged in satisfactory condition on the 17th day.CONCLUSION: the presented clinical case allows us to consider gluteoplasty as a promising method for reconstruction of the pelvic floor defect after ELAPR.

Laparoscopic extralevator abdominoperineal resection with perineal reconstruction with gluteal flap (clinical case)

AIM: to demonstrate the first experience of extralevator abdominoperineal resection (ELAPR) with gluteoplasty.PATIENTS AND METHODS: patient K., aged 71 years old, with a low rectal cancer cT3aN0M1a CRM– EMVI+ (IV st) after neoadjuvant chemoradiation therapy, underwent surgery. Laparoscopic extralevator abdominoperineal resection with gluteoplasty was performed.RESULTS: the patient was mobilized on the next day after surgery, the drain tubes were removed on the 5th day. On the 7th day, the seroma of the perineal wound without signs of suppuration was drained. No discomfort or movement disorders were noted. The patient was discharged in satisfactory condition on the 17th day.CONCLUSION: the presented clinical case allows us to consider gluteoplasty as a promising method for reconstruction of the pelvic floor defect after ELAPR.

Bilateral Sacrospinous Colposuspension (BSC) for the treatment of vaginal vault prolapse – description of a novel method

Vaginal vault prolapse is observed with increasing frequency in the era of large ageing populations. Various surgical techniques have been established, varying in performance, difficulty and outcome, specifically complications. A bilateral sacrospinous colposuspension technique (BSC) with a corresponding mesh prosthesis was developed using a direct I-Stitch fixation of the 38 micro-gram mesh from the vaginal apex or uterine cervix to the sacrospinous ligament or the para-sacral tendinous region for the treatment of an anatomical central pelvic floor defect. As a minimally invasive approach with the potential for conservation of the uterus, this technique should be applicable to all age groups including the increasingly frequent elderly patient with significant comorbidities.

CHOICE OF THE METHOD OF CLOSING THE PELVIC FLOOR DEFECT AFTER EXTRALEVATOR ABDOMINAL-PERINEAL EXTIRPATION OF THE RECTUM (PRACTICAL RECOMMENDATIONS)

Extralevator abdominal-perineal extirpation of the rectum causes a vast perineal wound, which requires to be closed. The article considers different approaches to perineal wound repair including primary closure, mesh reconstruction and muscular flap reconstruction.

Laparoscopic Repair of Postoperative Perineal Hernia

Perineal hernias are infrequent complications following abdominoperineal operations. Various approaches have been described for repair of perineal hernias including open transabdominal, transperineal or combined abdominoperineal repairs. The use of laparoscopic transabdominal repair of perineal hernias is not well-described. We present a case report demonstrating the benefits of laparoscopic repair of perineal hernia following previous laparoscopic abdominoperineal resection (APR) using a nonabsorbable mesh to repair the defect. We have demonstrated that the use of laparoscopy with repair of the pelvic floor defect using a non absorbable synthetic mesh offers an excellent alternative with many potential advantages over open transabdominal and transperineal repairs.