Perineal hernia after abdominoperineal resection (APR) remains a vexing problem for both patients and clinicians. In the current literature the incidence of symptomatic perineal hernia ranges from 7% to 30% [1-3]. A perineal hernia may cause discomfort, pain, wound healing problems, urogenital dysfunction and small bowel obstruction [4][5][6]. Depending on the severity of symptoms, preference and experience of the surgeon, an elective repair is sometimes considered. In contrast to abdominal wall hernias, literature on perineal hernia repair is very limited.Recurrence rates after surgical repair of a perineal hernia are high, and no consensus has been reached regarding the preferred method. Many options have been described, including primary
BACKGROUND: Chronic pelvic sepsis mostly originates from complicated pelvic surgery and failed interventions. This is a challenging condition that often requires extensive salvage surgery consisting of complete debridement with source control and filling of the dead space with well-vascularized tissue. OBJECTIVE: This study aimed to describe the outcomes of gluteal fasciocutaneous flaps for the treatment of secondary pelvic sepsis. DESIGN: Retrospective single-center cohort study. SETTINGS: Tertiary referral center. PATIENTS: Patients who underwent salvage surgery for secondary pelvic sepsis between 2012 and 2020 using a gluteal flap were included in this study. MAIN OUTCOME MEASURES: Percentage of complete wound healing. RESULTS: In total, 27 patients were included, of whom 22 underwent index rectal resection for cancer and 21 had undergone (chemo)radiotherapy. A median of 3 (interquartile range, 1–5) surgical and 1 (interquartile range, 1–4) radiological interventions preceded salvage surgery during a median period of 62 (interquartile range, 20–124) months. Salvage surgery included partial sacrectomy in 20 patients. The gluteal flap consisted of a V-Y flap in 16 patients, superior gluteal artery perforator flap in 8 patients, and a gluteal turnover flap in 3 patients. Median hospital stay was 9 (interquartile range, 6–18) days. During a median follow-up of 18 (interquartile range, 6–34) months, wound complications occurred in 41%, with a reintervention rate of 30%. The median time to wound healing was 69 (interquartile range, 33–154) days, with a complete healing rate of 89% at the end of follow-up. LIMITATIONS: Retrospective design and heterogeneous patient population. CONCLUSIONS: In patients undergoing major salvage surgery for chronic pelvic sepsis, the use of gluteal fasciocutaneous flaps is a promising solution because of the high success rate, limited risks, and relatively simple technique. See Video Abstract at http://links.lww.com/DCR/C160. RECONSTRUCCIÓN CON COLGAJO FASCIOCUTÁNEO GLÚTEO DESPUÉS DE UNA CIRUGÍA DE RESCATE POR SEPSIS PÉLVICA ANTECEDENTES: La sepsis pélvica crónica esta causada principalmente por cirugías pélvicas complicadas e intervenciones fallidas. Esta es una condición desafiante que a menudo requiere una cirugía de rescate extensa que consiste en un desbridamiento completo controlando el orígen infeccioso y rellenando el espacio muerto con tejido bien vascularizado, como por ejemplo un colgajo de tejido autólogo. La pared abdominal (colgajo de recto abdominal) o la pierna (colgajo de gracilis) se utilizan principalmente como sitios donantes para esta indicación, mientras que los colgajos glúteos pueden ser alternativas atractivas. OBJETIVO: Describir los resultados de los colgajos fasciocutáneos glúteos en el tratamiento de la sepsis pélvica secundaria. DISEÑO: Estudio de cohortes retrospectivo en un solo centro. AJUSTES: Centro de referencia terciario. PACIENTES: Todos aquellos que se sometieron a cirugía de rescate por sepsis pélvica secundaria entre 2012 y 2020 utilizando un colgajo fasciocutáneo glúteo. PRINCIPALES MEDIDAS DE RESULTADO: El porcentaje de cicatrización completa de la herida. RESULTADOS: En total, se incluyeron 27 pacientes, de los cuales 22 fueron sometidos a resección rectal por cáncer indicada y 21 pacientes que habían recibido (quimio)radioterapia. Una mediana de tres (RIC 1–5) intervenciones quirúrgicas y una (RIC 1–4) intervenciones radiológicas precedieron a la cirugía de rescate durante una mediana de 62 (RIC 20–124) meses. La cirugía de rescate incluyó una resección parcial del sacro en 20 pacientes. El colgajo fasciocutáneo glúteo consistió en la confección de un colgajo en V-Y en 16 pacientes, un colgajo incluyendo la perforante de la arteria glútea superior en 8 y un colgajo de rotación de músculo glúteo en 3 pacientes. La mediana de estancia hospitalaria fue de nueve (RIC 6–18) días. Durante una mediana de seguimiento de 18 (IQR 6–34) meses, se produjeron complicaciones de la herida en el 41%, con una tasa de reintervención del 30%. La mediana de tiempo hasta la cicatrización de la herida fue de 69 (IQR 33–154) días con una tasa de cicatrización completa del 89 % al final del seguimiento cicatricial. LIMITACIONES: Diseño retrospectivo y población heterogénea de pacientes. CONCLUSIONES: En pacientes sometidos a cirugía mayor de rescate por sepsis pélvica crónica, el uso de colgajos fasciocutáneos glúteos es una solución prometedora debido a la alta tasa de éxito, los riesgos limitados y la técnica relativamente simple. Video Resumen en http://links.lww.com/DCR/C160. (Traducción—Dr. Xavier Delgadillo)
Purpose This study aimed to establish the functional impact of displacement of urogenital organs after abdominoperineal resection (APR) using validated questionnaires. Methods Patients who underwent APR for primary or recurrent rectal cancer (2001–2018) with evaluable pre- and postoperative radiological imaging and completed urinary (UDI-6, IIQ-7) and sexual questionnaires (male, IIEF; female, FSFI, FSDS-R) were included from 16 centers. Absolute displacement of the internal urethral orifice, posterior bladder wall, distal end of the prostatic urethra, and cervix were correlated to urogenital function by calculating Spearman’s Rho (ρ). Median function scores were compared between minimal or substantial displacement using median split. Results There were 89 male and 36 female patients included, of whom 45 and 19 were sexually active after surgery. Absolute displacement of the internal urethral orifice and posterior bladder wall was not correlated with UDI-6 in men (ρ = 0.119 and ρ = 0.022) nor in women (ρ = − 0.098 and ρ = − 0.154). In men with minimal and substantial displacement of the internal urethral orifice, median UDI-6 scores were 10 (IQR 0–22) and 17 (IQR 5–21), respectively, with corresponding scores of 25 (IQR 10–46) and 21 (IQR 16–36) in women. Displacement of the cervix and FSDS-R were correlated (ρ = 0.433) in sexually active patients. Conclusion This first analysis on functional impact of urogenital organ displacement after APR suggests that more displacement of the cervix might be associated with worse sexual function, while the data does not indicate any potential functional impact of bladder displacement. Studies are needed to further explore this underexposed topic.
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