Pelvic reconstruction after abdominoperineal resection of the rectum

Moreno-Sanz, Carlos; Manzanera-Díaz, Marina; Clerveus, Mikael; Cortina-Oliva, F. Javier; Pedro-Conal, Julián de; Picazo-Yeste, Joaquín

doi:10.1016/s2173-5077(11)70011-4

Cited by 3 publications

(3 citation statements)

References 47 publications

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“…All the surgical procedures were performed under general anaesthesia and in a double surgical equipe: one for the abdominal laparoscopic approach and one for the perineal dissection. Therefore, the dissection of the pelvic rectum proceeded in both directions simultaneously, with the two operators performing a kind of rendezvous at the level of the elevator plane, with considerable advantages for the patient [18][19][20].…”

Section: Surgical Technique 231 Conventional Abdominoperineal Resectionmentioning

confidence: 99%

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Biosynthetic Mesh Reconstruction after Abdominoperineal Resection for Low Rectal Cancer: Cross Relation of Surgical Healing and Oncological Outcomes: A Multicentric Observational Study

Gambardella

Mongardini

Karpathiotakis

et al. 2023

Cancers

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Background: Local wound complications are among the most relevant sequelae after an abdominoperineal resection (APR) for low rectal cancer. One of the proposed techniques to improve the postoperative recovery and to accelerate the initiation of adjuvant chemotherapy is the mesh reinforcement of the perineal wound. The aim of the current study is to compare the surgical and oncological outcomes after APR performed with a biosynthetic mesh reconstruction versus the conventional procedure. Methods: From 2015 to 2020, in two tertiary centres, the surgical outcomes, the wound events (i.e., surgical site infections, wound dehiscence and the complete healing time) and the oncological outcomes (i.e., time length to start adjuvant chemo-radiotherapy, an over 8-week delay in chemotherapy and the recurrence rate) were retrospectively analysed in patients undergoing APR reinforced with biosynthetic mesh (Group A) and conventional APR (Group B). Results Sixty-one patients were treated with APR (25 in Group A and 36 in Group B). Patients in Group A presented lower time for: healing (16 versus 24 days, p = 0.015), inferior perineal wound dehiscence rates (one versus nine cases, p = 0.033), an earlier adjuvant therapy start (26 versus 70 days, p = 0.003) and a lower recurrence rate (16.6% vs. 33.3%, p = 0.152). Conclusions: In our series, the use of a biosynthetic mesh for the neo-perineum reconstruction after a Miles’ procedure has resulted in safe, reproducible results affected by limited complications, guarantying a rapid start of the adjuvant therapy with clear benefits in oncological outcomes. Further randomized clinical trials with long-term follow-up are needed to validate these results.

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Section: Surgical Technique 231 Conventional Abdominoperineal Resectionmentioning

confidence: 99%

“…The main surgical techniques for perineal reconstruction after APR, in addition to the direct closure of the perineal wound where it is technically possible, include fascialmyocutaneous flaps, omentoplasty, tissue expanders, silicone breast implants and synthetic or biological prostheses [16][17][18][19][20].…”

Section: Introductionmentioning

confidence: 99%

Biosynthetic Mesh Reconstruction after Abdominoperineal Resection for Low Rectal Cancer: Cross Relation of Surgical Healing and Oncological Outcomes: A Multicentric Observational Study

Gambardella

Mongardini

Karpathiotakis

et al. 2023

Cancers

View full text Add to dashboard Cite

show abstract

“…Fixation of the bladder to the sacral promontory might theoretically increase the urethrovesical angle and predispose to stress incontinence. Pelvic occlusion with a prosthetic material prevents the bowels from adhering to other tissues and from exposure to radiation, if postoperative radiotherapy is used [11]. However, the use of these materials can cause complications such as infection, fistulation, vascular erosion which may require re‐operations with significant morbidity [12,13].…”

Section: Introductionmentioning

confidence: 99%