• Biological mesh
• Extralevator abdominoperineal excision (ELAPE)
• Flap
• Optimal technique
• Perineal reconstruction

• Abdominoperineal resection
• Extraperitoneal stoma construction
• Laparoscopy
• Low rectal cancer
• Pelvic peritoneal closure
• Postoperative complications

• Humans
• Female
• Rectal Neoplasms/surgery
• Middle Aged
• Retrospective Studies
• Colostomy/adverse effects
• Colostomy/methods
• Intestinal Obstruction/etiology
• Intestinal Obstruction/epidemiology
• Male
• Postoperative Complications/etiology
• Postoperative Complications/epidemiology
• Proctectomy/adverse effects
• Proctectomy/methods
• Laparoscopy/adverse effects
• Laparoscopy/methods
• Peritoneum/surgery
• Colon, Sigmoid/surgery
• Aged
• Incidence
• Operative Time
• Treatment Outcome
• Adult
• Pelvis/surgery

• 201809 Shanxi Province Service Innovation Industry Discipline Group Construction Plan Project
• HPYJ201931 The Hospital-level Research Fund of the Peace Affiliated Hospital of Changzhi Medical College in 2019

• Humans
• Middle Aged
• Blood Loss, Surgical/prevention & control
• Laparoscopy/methods
• Neoplasm Recurrence, Local/surgery
• Rectal Neoplasms/surgery

• National Natural Science Foundation of China

• APR
• Colorectal surgery
• ELAPR
• Mesh reconstruction
• Perineal hernia
• Quality of life

• Male
• Humans
• Aged
• Female
• Retrospective Studies
• Surgical Mesh
• Neoplasm Recurrence, Local
• Proctectomy
• Neoadjuvant Therapy
• Cutaneous Fistula

• APE
• ELAPE
• extralevator abdominoperineal excision
• magnetic resonance imaging
• rectal cancer

• colorectal surgery
• guidance
• mesh
• perineal reconstruction
• prolapse

• Colorectal Surgery
• Digestive System Surgical Procedures
• Humans
• Pelvis/surgery
• Prostheses and Implants
• Surgical Mesh

• European Society of Coloproctology

• Abdominoperineal excision
• Cancer
• Perineal closure
• Rectum

Extralevator abdominoperineal excision (ELAPE), abdominoperineal excision (APE) or pelvic exenteration (PE) with or without sacral resection (SR) for locally advanced rectal cancer leaves a significant defect in the pelvic floor. At first, this defect was closed primarily. To prevent perineal hernias, the use of a biological mesh to restore the pelvic floor has been increasing. The aim of this study, was to evaluate the outcome of the use of a biological mesh after ELAPE, APE or PE with/without SR.

A retrospective study was conducted on patients who had ELAPE, APE or PE with/without SR with a biological mesh (Permacol™) for pelvic reconstruction in rectal cancer in our center between January 2012 and April 2015. The endpoints were the incidence of perineal herniation and wound healing complications.

Data of 35 consecutive patients [22 men, 13 women; mean age 62 years (range 31–77 years)] were reviewed. Median follow-up was 24 months (range 0.4–64 months). Perineal hernia was reported in 3 patients (8.6%), and was asymptomatic in 2 of them. The perineal wound healed within 3 months in 37.1% (n = 13), within 6 months in 51.4% (n = 18) and within 1 year in 62.9% (n = 22). In 17.1% (n = 6), the wound healed after 1 year. It was not possible to confirm perineal wound healing in the remaining 7 patients (20.0%) due to death or loss to follow-up. Wound dehiscence was reported in 18 patients (51.4%), 9 of whom needed vacuum-assisted closure therapy, surgical closure or a flap reconstruction.

Closure of the perineal wound after (EL)APE with a biological mesh is associated with a low incidence of perineal hernia. Wound healing complications in this high-risk group of patients are comparable to those reported in the literature.

• Biological mesh
• Extralevator abdomino perineal excision
• Pelvic exenteration
• Perineal hernia
• Permacol
• Rectal cancer surgery
• Wound healing

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.

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).

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%.

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.

• Abdominoperineal excision
• Hernia
• Rectal cancer
• Surgical mesh

Pelvic floor peritoneum reconstruction is a key step in various standard resections for open radical rectal cancer. However, during endoscopic surgery, most surgeons do not close the pelvic floor peritoneum. This study aims to evaluate the efficacy of pelvic peritonization during laparoscopic Dixon surgery using an observational study.

A total of 189 patients, who underwent laparoscopic Dixon surgery at Tianjin Union Medical Center, China, were analyzed retrospectively. All of the cases were divided into two groups according to the differences of surgical procedure. The 92 patients in Group A (observation group) underwent pelvic peritonization and the 97 patients in Group B (control group) did not undergo this procedure. Postoperative complications were observed in the two groups, compared, and analyzed using the Chi-square or Fisher's exact test.

The incidence of anastomotic leakage was significantly lower in Group A than in Group B (P = 0.014). A significant difference was found in the postoperative short-term (P = 0.029) and long-term (P = 0.029) ileus rates between the two groups, with Group A exhibiting a lower rate than Group B. Patients in Group A had significantly lower rates of postoperative infections than those in Group B (χ² = 7.606, P = 0.006; χ² = 4.464, P = 0.035). Patients in Group A had significantly lower rates of deep venous thrombosis than those in Group B (χ² = 8.531, P = 0.003).

Pelvic peritonization effectively reduces postoperative complications, such as anastomotic leakage, which warrants its increased use in laparoscopic surgery.

• APER
• ELAPE
• abdominoperineal
• closure
• extra-levator
• resection

• Abdominoperineal Excision
• Complications
• Individualized
• Low Rectal Cancer
• Recurrence

• Aged
• Female
• Humans
• Male
• Middle Aged
• Neoplasm Recurrence, Local/pathology
• Neoplasm Recurrence, Local/surgery
• Operative Time
• Perineum/surgery
• Postoperative Complications
• Rectal Neoplasms/pathology
• Rectal Neoplasms/surgery
• Rectum/surgery
• Retrospective Studies
• Treatment Outcome

To share our experience of extra-levator abdominoperineal excision (ELAPE) for low rectal cancer, focusing on perineal repair with biological mesh.

We retrospectively analyzed medical records of all patients with low rectal cancer who underwent the ELAPE procedure using biological mesh for perineal repair at the Gastrointestinal Surgery of Nanjing Drum Power Hospital between January 2013 and September 2015. All patients were closely followed up to now.

A total of 17 patients underwent ELAPE for low rectal cancer was screened. Of these, 15 patients had primary rectal cancer, 1 had local recurrent rectal cancer, and 1 had malignant melanoma. All patients underwent ELAPE successfully without intestinal perforation and got stage I healing in perineum wound without incision infection, dehiscence, cystocele perinealis, urethral dysfunction or intestinal obstruction. Perineum wound hematoma developed in just one patient and had successful percutaneous drainage in one week. During the follow-up, there was no recurrence, perineal hernia, sexual dysfunction, urinary retention, or bowel obstruction. Two patients described slight pain in the sacrococcygeal region without special handling.

ELAPE is applicable to low rectal cancer. Biological mesh reconstruction of perineal defect seems to be safe and effective, with high patient compliance.

• ELAPE
• biological mesh
• extra-levator abdominoperineal excision
• low rectal cancer
• pelvic reconstruction

Extralevator abdominoperineal excision and pelvic exenteration are mutilating operations that leave wide perineal wounds. Such large wounds are prone to infection and perineal herniation, and their closure is a major concern to most surgeons. Different approaches to the perineal repair exist, varying from primary or mesh closure to myocutaneous flaps. Each technique has its own associated advantages and potential complications and the ideal approach is still debated. In the present study, we reviewed the current literature and our own local data regarding the use of biological mesh for perineal wound closure. Current evidence suggests that the use of biological mesh carries an acceptable risk of wound complications compared to primary closure and is similar to flap reconstruction. In addition, the rate of perineal hernia is lower in early follow-up, while long-term hernia occurrence appears to be similar between the different techniques. Finally, it is an easy and quick reconstruction method. Although more expensive than primary closure, the cost associated with the use of a biological mesh is at least equal, if not less, than flap reconstruction.

• Biological mesh
• Rectal cancer
• Pelvic exenteration
• Abdominoperineal resection
• Primary perineal wound closure
• Perineal wound infection
• Perineal hernia

• Extra levator abdomino perineal resection (ELAPER)
• conventional abdominoperineal resection (APER)
• rectal cancer

• abdominoperineal excision
• extralevator
• perineal wound
• reconstruction
• rectal cancer

• circumferential margin
• extralevator abdominoperineal resection
• long-course chemoradiotherapy

The aim of this review is to provide an overview of the evidence for the use of biologic mesh in the reconstruction of the pelvic floor after extralevator abdominoperineal excision of the rectum (ELAPE).

A systematic search of PubMed was conducted using the search terms: “ELAPE,” “extralevator abdominoperineal excision of rectum,” or “extralevator abdominoperineal resection.” The search yielded 17 studies.

Biologic mesh was used in perineal reconstruction in 463 cases. There were 41 perineal hernias reported but rates were not consistently reported in all studies. The most common complications were perineal wound infection (n = 93), perineal sinus and fistulae (n = 26), and perineal haematoma or seroma (n = 11). There were very few comparative studies, with only one randomized control trial (RCT) identified that compared patients undergoing ELAPE with perineal reconstruction using a biological mesh, with patients undergoing a conventional abdominoperineal excision of the rectum with no mesh. There was no significant difference in perineal hernia rates or perineal wound infections between the groups. Other comparative studies comparing the use of biologic mesh with techniques, such as the use of myocutaneous flaps, were of low quality.

Biologic mesh-assisted perineal reconstruction is a promising technique to improve wound healing and has comparable complications rates to other techniques. However, there is not enough evidence to support its use in all patients who have undergone ELAPE. Results from high-quality prospective RCTs and national/international collaborative audits are required.

• ELAPE
• biological mesh
• extralevator abdominoperineal excision of rectum
• extralevator abdominoperineal resection
• pelvic floor reconstruction

• Laparoscopic abdominal perineal resection
• Perineal wound complications
• Translevator approach

• Adenocarcinoma/surgery
• Adult
• Aged
• Anastomosis, Surgical
• Female
• Humans
• Laparoscopy/methods
• Male
• Middle Aged
• Neoplasm Recurrence, Local/surgery
• Perineum/surgery
• Postoperative Complications
• Prognosis
• Rectal Neoplasms/surgery
• Retrospective Studies
• Treatment Outcome

• Fournier’s gangrene
• Necrotizing fasciitis
• Necrotizing soft tissue infections
• Oncological treatment
• Proctological examination
• Reconstructive surgery
• Rectal cancer
• Surgical treatment

• Anti-Bacterial Agents/therapeutic use
• Chemoradiotherapy, Adjuvant
• Colostomy
• Diagnosis, Differential
• Digestive System Surgical Procedures
• Fournier Gangrene/diagnosis
• Fournier Gangrene/epidemiology
• Fournier Gangrene/microbiology
• Fournier Gangrene/surgery
• Humans
• Incidence
• Predictive Value of Tests
• Plastic Surgery Procedures
• Rectal Neoplasms/diagnosis
• Rectal Neoplasms/epidemiology
• Rectal Neoplasms/surgery
• Risk Factors
• Treatment Outcome

• incisional hernia
• incisional reinforcement
• mesh reinforcement
• wound closure