Biological mesh reconstruction versus primary closure for preventing perineal morbidity after extralevator abdominoperineal excision: a multicentre retrospective study

Abstract

Aim The aim of the study was to compare the incidence of perineal hernia and the perineal wound morbidity following extralevator abdominoperineal excision (ELAPE) between two groupsprimary perineal closure and reconstruction with a biological mesh. Method One hundred and forty-seven consecutive patients who underwent ELAPE for primary rectal cancer between January 2007 and December 2018 in two tertiary referral centres were retrospectively identified from prospective databases. Perineal closure was carried out via primary closure or with a biological mesh (porcine dermal collagen mesh). Outcome measures were perineal hernia and perineal wound morbidity (infection, dehiscence, persistent sinus and chronic pain). Results A total of 139 patients were included in the study. A prophylactic mesh was used in 80 (57.5%) and primary closure was practised in 59 (42.4%) patients. The median follow-up was 30 (interquartile range 46.88) months. Thirty patients (21.6%) developed perineal hernia. No significant differences were found between prophylactic mesh and primary closure (16.3% vs 23.3%, P = 0.07). The median period between surgery and hernia diagnosis was 8 months in the primary closure group and 24 months in the mesh group (P < 0.01). Perineal wound morbidity was significantly higher in the prophylactic mesh group (55% vs 33.9%, P < 0.01). Conclusion In our study, the use of a biological mesh did not reduce the rate of perineal hernia, although it did delay its appearance. Perineal closure using a biological mesh may increase perineal morbidity, both acute and chronic. Keywords Biological mesh, extralevator abdominoperineal excision, perineal wound morbidity, rectal cancer, primary perineal wound closure What does this paper add to literature? Although diverse methods have been described for repairing the pelvic floor defect after extralevator abdominoperineal excision there is still no consensus as to which closure technique should be applied. This paper shows similar results between primary closure and biological mesh in perineal closure in one of the largest series in Europe.

A case of successful laparoscopic intraperitoneal onlay mesh plus technique repair for perineal hernia after laparoscopic abdominoperineal resection

“…Although a previous report described primary closure of the pelvic floor using a biological mesh after extralevator abdominoperineal excision of rectal cancer, no significant differences in the rate of perineal hernia were seen between biological mesh and primary closure 10 . Perineal wound morbidity was significantly higher with biological mesh repair 10 . Some reports have described therapeutic options for perineal hernia 1,10 .…”

“…Perineal wound morbidity was significantly higher with biological mesh repair 10 . Some reports have described therapeutic options for perineal hernia 1,10 . Mesh placement in the pelvic cavity in advance of rectal cancer surgery was not considered optimal in terms of treatment outcomes and infection control 10 .…”

“…Some reports have described therapeutic options for perineal hernia 1,10 . Mesh placement in the pelvic cavity in advance of rectal cancer surgery was not considered optimal in terms of treatment outcomes and infection control 10 . In comparisons of treatment surgery for symptomatic perineal hernia, 1,3‐5 various surgical approaches have been reported 1,3‐5 .…”

Long-term outcomes of laparoscopic Extralevator Abdominoperineal excision with modified position change for low rectal Cancer treatment

“…Though the studies reported acceptable or favorable results regarding the methods mentioned above, no consensus was achieved on the optimal method. A recent multi-center retrospective study indicated that the application of biological mesh could not reduce the incidence of perineal hernia, and even increase perineal morbidity [ 29 ]. Result from a meta-analysis study found that compared to primary closure, reconstruction with biologic mesh was associated with a lower hernia rate, but it had no effect on perineal wound complications [ 30 ].…”

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

“…в своем мультицентровом ретроспективном исследовании, которое включило 139 пациентов, перенесших ЭлБПЭ ПК, оценивали частоту возникновения послеоперационной грыжи у пациентов после пластики промежностной раны сеткой и после простого послойного ушивания раны. Частота возникновения послеоперационной грыжи в группе после пластики сеткой составила 16,3% и в группе после простого ушивания раны -23,3%, p = 0,07 [9]. Данные систематического обзора Mr Foster J.D.…”