Perineal hernia formation following extralevator abdominoperineal excision

Sayers, Adele E.; Patel, Rikesh; Hunter, Iain Andrew

doi:10.1111/codi.12843

Cited by 82 publications

(63 citation statements)

References 16 publications

(27 reference statements)

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“…The use of myocutaneous flaps to close the perineal defect after ELAPE adds additional complexity, time, cost and risk of complication both at the perineum and the donor site [18,28]. Closure with mesh be it synthetic or biological also ads cost although may reduce the risk of perineal hernia – a morbid complication requiring complex surgery to repair [[29], [30], [31]]. A recent systematic review demonstrated significant increase in wound complications in their secondary analyses although Musters et al recent published a meta-analysis specifically examining wound healing and demonstrated no significant difference between standard APR and ELAPE [32].…”

Section: Discussionmentioning

confidence: 99%

“…The larger perineal defect left following ELAPE may require additional resources to close either with mesh, be that synthetic or biological, or complex plastic surgery [18]. ELAPE has increased morbidity; with reported complication rates of up to 50% including perineal wound breakdown and revision, perineal hernia, chronic sinus and donor site complications if myocutaneous flap reconstruction is required [2,15,19]. In addition, within both the standard APR and ELAPE the anterior resection plane remains the same.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Oncological outcomes of abdominoperineal resection for the treatment of low rectal cancer: A retrospective review of a single UK tertiary centre experience

Hussain

Mahmood

Torrance

et al. 2018

Annals of Medicine and Surgery

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BackgroundThe use of abdominoperineal resection (APR) in the management of low rectal cancer has received criticism over high rates of incomplete resection due to tumour involvement at the circumferential resection margin. Extralevator abdominoperineal resection has been advocated as a means of improving complete resection. However, Extralevator abdominoperineal resection can result in increased cost, morbidity and reduced quality of life.This study aims to assess the histological features and long-term outcomes of patients undergoing standard abdominoperineal resection and discusses the potential role of Extralevator abdominoperineal resection in this cohort.MethodA retrospective review of a prospectively maintained database of rectal cancer patients at a single centre. Patients undergoing standard APR were included from 01/06/2007 to 31/05/2012 to allow a minimum 2-year follow-up. Data was collected on age, gender, co-morbidity, pre-operative stage, neo-adjuvant therapy, histology, recurrence and mortality.ResultsSeventy patients were identified (45 (64%) male, median age 67; (range 36–85)). 12 (17.1%) patients had a positive circumferential resection margin; 4 (6.1%) tumours were located anteriorly, 8 (11%) were located posteriorly or laterally and may potentially have been completely resected with extralevator abdomino-perineal resection, Number-needed to treat = 9. Positive circumferential resection margin was more common in advanced tumours (p < 0.001). Local recurrence was more common with positive circumferential resection margins (16.7% Vs 0%, p = 0.027), with no statistically significant difference in 5-year survival, although there was a tendency towards worse survival in these patients.ConclusionPositive circumferential resection margin following APR resulted in significantly increased local recurrence with a trend towards poorer survival outcomes. Extralevator abdomino-perineal resection may have benefited some of these patients with locally advanced tumours and postero-lateral recurrences. However, this has to be balanced against exposing patients to increased risk of adverse events. We would recommend selective use of Extralevator abdominoperineal resection for locally advanced and node-positive tumours although further studies to help refine selection criteria are required with long-term follow-up.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Oncological outcomes of abdominoperineal resection for the treatment of low rectal cancer: A retrospective review of a single UK tertiary centre experience

Hussain

Mahmood

Torrance

et al. 2018

Annals of Medicine and Surgery

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“…Laparoscopy minimizes pain, facilitates a reduction in length of stay and return to activities. However, the increase in laparoscopic ELAPE techniques may increase perineal herniation rates possibly as high as 45% (6). Advocates propose either perineal, abdominal or combination approach but as yet no consensus has been proposed.…”

Section: Discussionmentioning

confidence: 99%

Laparoscopic Repair of Perineal Hernia Using a Double-Mesh Technique

2015

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Introduction: Perineal herniation following pelvic surgery, including abdomino-perineal resection (APR) and pelvic exenteration is a rare condition but can present with serious complications. Multiple methods of repair are possible including either an abdominal or perineal approach. Laparoscopic abdominal repairs have been described. Case Presentation: An 83 year-old lady, under follow-up following a laparoscopic APR two years previously for a T2N0M0 low rectal cancer, presented with a symptomatic perineal hernia which caused significant impairment in her daily living activities. She had no major comorbidities and was keen for intervention. She was electively admitted for a laparoscopic repair of perineal hernia. This was performed using a double-mesh technique, which allows strengthening of the repair as a feasible alternative to consider in repair of this difficult complication. Conclusions:This technique is feasible as an alternative to standard laparoscopic or perineal repair of perineal herniation. Further studies are required to demonstrate its long-term efficacy.

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“…Primary closure of the perineal wound after ELAPE has been reported in four studies containing 345 patients [11,19,32,33]. Outcomes from these studies are summarised in Table 3.…”

Section: Elape -Primary Perineal Wound Closurementioning

confidence: 99%

Closure of the perineal defect after abdominoperineal excision for rectal adenocarcinoma – ACPGBI Position Statement

et al. 2018

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Perineal hernia formation following extralevator abdominoperineal excision

Abstract: Perineal hernia formation was the commonest perineal complication of ELAPE and occurred in nearly half of patients having a laparoscopic ELAPE.

Cited by 82 publications

References 16 publications

Oncological outcomes of abdominoperineal resection for the treatment of low rectal cancer: A retrospective review of a single UK tertiary centre experience

Oncological outcomes of abdominoperineal resection for the treatment of low rectal cancer: A retrospective review of a single UK tertiary centre experience

Laparoscopic Repair of Perineal Hernia Using a Double-Mesh Technique

Closure of the perineal defect after abdominoperineal excision for rectal adenocarcinoma – ACPGBI Position Statement

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