Perineal reconstruction after extra-levator abdominoperineal excision (eLAPE): a systematic review

Abstract

The paucity of high quality data, suggests that a prospective, randomised trial is needed to determine the ideal technique for perineal reconstruction following eLAPE.

Oncological and quality of life outcomes following extralevator versus standard abdominoperineal excision for rectal cancer

“…Perineal wound complications are among the most common complications of abdominoperineal resection, occurring in 20-58% of cases. 19 While no significant differences were observed between the two patient groups in our study, our findings are generally similar to previous results. 15 With regard to QoL, the mean global health status score for the ELAPE cohort of 79.2 is lower than reported previously.…”

Short-term outcomes of the modified extralevator abdominoperineal resection for low rectal cancer (with videos)

“…Because rigid pelvic structures made a dead space following APR, the perineal wound was vulnerable to postoperative infection and delayed healing due to excessive tension and devascularization. Perineal wound infection, delayed healing, abscess, wound dehiscence and persistent perineal sinus occurred, and the incidence was estimated in the range of 10-40 % [21]. Although extralevator APR showed oncologic superiority, it was reported that perineal wound complications of extralevator APR were twice as higher than conventional APR [9].…”

“…Although various wound techniques were developed, we should be reminded that wound healing can be compromised by the high-risk factors such as diabetes, smoking, increased BMI and comorbidities such as inflammatory bowel disease [13,21,23]. Radiation-related perineal complications were reported for short-course and longcourse RT in the previous randomized controlled trials [25].…”

“…Postoperative outcomes demonstrated that days to passage of flatus were 2.3 ± 0.9 day (1-4) and days to first soft diet was 4.7 ± 3.4 day (3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15). The mean hospital day was 11.2 ± 4.7 day (5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21). Postoperative complications, stratified by Dindo-Clavien classification showed two cases of grade I, two cases of grade II and one case of grade III.…”

Dynamic Article

“…17 on the other hand, there are concerns of mesh infection, delayed wound healing, mesh exposure in the setting of wound dehiscence and even enterocutaneous fistula formation after repair with both synthetic and biological mesh. 20 Primary flap reconstruction after traditional aPR has been definitively shown to reduce the incidence of complications and need for reoperation. 21 major perineal complications are less common with flap reconstruction (3.5%-15.8%) than with primary closure (25%-46%).…”