Long-term outcomes of biological mesh repair following extra levator abdominoperineal excision of the rectum: an observational study of 100 patients.

Autor: Thomas PW; Department of Colorectal Surgery, Royal Derby Hospital, Derby, DE22 3NE, UK., Blackwell JEM; Department of Colorectal Surgery, Royal Derby Hospital, Derby, DE22 3NE, UK., Herrod PJJ; Department of Colorectal Surgery, Royal Derby Hospital, Derby, DE22 3NE, UK. pherrod@nhs.net.; Medical Research Council-Arthritis Research UK Centre for Musculoskeletal Ageing Research, University of Nottingham, Royal Derby Hospital, Derby, DE22 3DT, UK. pherrod@nhs.net., Peacock O; Department of Colorectal Surgery, Royal Derby Hospital, Derby, DE22 3NE, UK., Singh R; Department of Radiology, Royal Derby Hospital, Derby, DE22 3NE, UK., Williams JP; Department of Colorectal Surgery, Royal Derby Hospital, Derby, DE22 3NE, UK.; Medical Research Council-Arthritis Research UK Centre for Musculoskeletal Ageing Research, University of Nottingham, Royal Derby Hospital, Derby, DE22 3DT, UK., Hurst NG; Department of Colorectal Surgery, Royal Derby Hospital, Derby, DE22 3NE, UK., Speake WJ; Department of Colorectal Surgery, Royal Derby Hospital, Derby, DE22 3NE, UK., Bhalla A; Department of Colorectal Surgery, Royal Derby Hospital, Derby, DE22 3NE, UK., Lund JN; Department of Colorectal Surgery, Royal Derby Hospital, Derby, DE22 3NE, UK.; Medical Research Council-Arthritis Research UK Centre for Musculoskeletal Ageing Research, University of Nottingham, Royal Derby Hospital, Derby, DE22 3DT, UK.
Jazyk: angličtina
Zdroj: Techniques in coloproctology [Tech Coloproctol] 2019 Aug; Vol. 23 (8), pp. 761-767. Date of Electronic Publication: 2019 Aug 07.
DOI: 10.1007/s10151-019-02056-0
Abstrakt: Background: Current evidence suggests that pelvic floor reconstruction following extralevator abdominoperineal excision of rectum (ELAPER) may reduce the risk of perineal herniation of intra-abdominal contents. Options for reconstruction include mesh and myocutaneous flaps, for which long-term follow-up data is lacking. The aim of this study was to evaluate the long-term outcomes of biological mesh (Surgisis ® , Biodesign™) reconstruction following ELAPER.
Methods: A retrospective review of all patients having ELAPER in a single institution between 2008 and 2018 was perfomed. Clinic letters were scrutinised for wound complications and all available cross sectional imaging was reviewed to identify evidence of perineal herniation (defined as presence of intra-abdominal content below a line between the coccyx and the lower margin of the pubic symphysis on sagittal view).
Results: One hundred patients were identified (median age 66, IQR 59-72 years, 70% male). Median length of follow-up was 4.9 years (IQR 2.3-6.7 years). One, 2- and 5-year mortality rates were 3, 8 and 12%, respectively. Thirty three perineal wounds had not healed by 1 month, but no mesh was infected and no mesh needed to be removed. Only one patient developed a symptomatic perineal hernia requiring repair. On review of imaging a further 7 asymptomatic perineal hernias were detected. At 4 years the cumulative radiologically detected perineal hernia rate was 8%.
Conclusions: This study demonstrates that pelvic floor reconstruction using biological mesh following ELAPER is both safe and effective as a long-term solution, with low major complication rates. Symptomatic perineal herniation is rare following mesh reconstruction, but may develop sub clinically and be detectable on cross-sectional imaging.
Databáze: MEDLINE
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