EP-605 Perineal Partial Myocutaneous Gluteal (PMG) Flap Reconstruction after Extra Levator Abminoperineal Excision (ELAPE): Recent Experience and Outcome

Abstract

Background Extra Levator Abminoperineal Excision (ELAPE) is widely performed surgery for low rectal cancers. A large defect in the perineum adds significant post-operative morbidity. There is no clear unanimity about the closure of the defect. The aim of the study is to evaluate our experience and outcome of the perineal wound management after ELAPE with partial myocutaneous gluteal (PMG) flap reconstruction in a large series of 81 patients at a single centre in the United Kingdom (UK). Method Retrospective review of all patients undergoing ELAPE and primary PMG flap reconstruction between January 2012 and December 2021 in a large district general hospital. Patient demographics, 30 days morbidity and mortality were studied. Results Total 81 patients (male 52, female 29) had ELAPE (laparoscopic 65, open 11, converted to open 5) and PMG flap closure for low rectal cancer. Mean age of patients was 67.2 years (SD+- 10.7). Length of stay was average 19 days (range: 6 to 168 days). Half of the total patients had neoadjuvant chemoradiation. 18.5% patients developed minor perineal wound complications, whereas only 2.5% patients needed to return to theatre for major wound complications. None of patients had perineal hernia or mortality in 30 days. All flaps were viable during the follow-up. Conclusion PMG flap provides safe and reliable method for perineal closure after ELAPE perineal defect without any additional morbidity compared to conventional closure offering overall good patient outcome and experience.