scholarly journals Dynamic Magnetic Resonance Imaging Demonstrates the Integrity of Perineal Reconstruction following Cylindrical Abdominoperineal Excision with Reconstruction of the Pelvic Floor Using Porcine Collagen

2012 ◽  
Vol 2012 ◽  
pp. 1-5 ◽  
Author(s):  
D. O. Kavanagh ◽  
H. Imran ◽  
A. Almoudaris ◽  
P. Ziprin ◽  
O. Faiz
Keyword(s):  
Pelvic Floor ◽  
Clinical Evidence ◽  
Digital Rectal Examination ◽  
Dynamic Mri ◽  
Posterior Wall ◽  
Abdominoperineal Excision ◽  
Perineal Hernia ◽  
En Bloc ◽  
Rectal Pain ◽  
Radiological Staging

A 72-year-old female presented with a six-month history of increased frequency of defecation, rectal bleeding, and severe rectal pain. Digital rectal examination and endoscopy revealed a low rectal lesion lying anteriorly. This was confirmed histologically as adenocarcinoma. Radiological staging was consistent with a T3N2rectal tumour. Following long-course chemoradiotherapy repeat staging did not identify any metastatic disease. She underwent a laparoscopic cylindrical abdominoperineal excision withen blocresection of the coccyx and posterior wall of the vagina with a negative circumferential resection margin. The perineal defect was reconstructed with Permacol (biological implant, Covidien) mesh. She had no clinical evidence of a perineal hernia at serial followup. Dynamic MRI images of the pelvic floor obtained during valsalva at 10 months revealed an intact pelvic floor. A control case that had undergone a conventional abdominoperineal excision with primary perineal closure without clinical evidence of herniation was also imaged. This confirmed subclinical perineal herniation with significant downward migration of the bowel and bladder below the pubococcygeal line. We eagerly await further evidence supporting a role for dynamic MR imaging in assessing the integrity of a reconstructed pelvic floor following cylindrical abdominoperineal excision.

scholarly journals Closed loop obstruction and adhesive intestinal obstruction in perineal hernia

2020 ◽  
Vol 13 (12) ◽  
pp. e238112
Author(s):  
Ramprasad Rajebhosale ◽  
Mohammad Miah ◽  
Fraser Currie ◽  
Pradeep Thomas
Keyword(s):  
Small Bowel ◽  
Intestinal Obstruction ◽  
Rare Case ◽  
Transition Point ◽  
Closed Loop ◽  
Abdominoperineal Excision ◽  
Perineal Hernia ◽  
Bowel Gangrene ◽  
Adhesive Intestinal Obstruction

Perineal hernia with bowel gangrene is uncommon but known complication of laparoscopic extralevator abdominoperineal excision (ELAPE). We present a rare case of closed loop small bowel obstruction with bowel gangrene secondary to an incarcerated perineal hernia that developed 7 years after an ELAPE. Intraoperatively, we found a definitive transition point due to adhesions in pelvis and a closed loop obstruction of the distal small bowel at different site with gangrenous intestine. She was managed successfully surgically with adhesiolysis and fixation of defect with biological mesh. Prevalence of perineal hernias will rise in future because of the increasing cases of ELAPE, in which no repair of pelvic floor is performed. The need of follow-up of these operations and more reporting of such cases are important in increasing awareness of these complications. Patients should be made aware of such complications and should seek urgent medical care.

067 Dynamic MRI of the Male Pelvic Floor

2021 ◽  
Vol 18 (3) ◽  
pp. S36-S37
Author(s):  
I. Pyatnitskiy ◽  
R. Ovchinnikov ◽  
S. Ivanov ◽  
V. Mitrokhin ◽  
B. Aleksandrov
Keyword(s):  
Pelvic Floor ◽  
Dynamic Mri

Rare case of angiofibroma presenting as perineal hernia

2021 ◽  
Vol 14 (1) ◽  
pp. e236661
Author(s):  
Ruchika Kumari ◽  
Cherring Tandup ◽  
Ambuj Agarwal ◽  
Anish Chowdhury
Keyword(s):  
Soft Tissue ◽  
Case Reports ◽  
En Bloc Resection ◽  
Perineal Hernia ◽  
Pathological Examination ◽  
Soft Tissue Tumour ◽  
Open Approach ◽  
En Bloc ◽  
Rare Tumour ◽  
Tissue Tumour

Angiofibroma is a benign soft tissue tumour presenting as a gradually progressive swelling in the vulvovaginal area in women and in the inguinoscrotal region in men. Being a rare tumour, there are only a few case reports in the literature, and among them, presentation as perineal herniation is very rare. En bloc resection of angiofibroma either via laparoscopic or open approach is the choice of treatment to avoid recurrence. Detailed pathological examination and immunohistochemistry workup are imperative to distinguish it from various mesenchymal tumours. Perineal hernia is itself rare and may occur spontaneously or following abdominoperineal resection, sacrectomy or pelvic exenteration. Surgical repair via open transabdominal and transperineal approaches has been described. Here, we report a case of a young woman who presented with spontaneous reducible perineal hernia with a soft tissue tumour as its content, which on histopathological investigation was found to be an angiofibroma.

scholarly journals The results of use of myoplasty for closure of the pelvic floor defect after extralevator abdominoperineal excision of the rectum

2019 ◽  
Vol 17 (6) ◽  
pp. 35-40
Author(s):  
N. A. Domansky ◽  
V. V. Semiglazov ◽  
A. M. Karachun ◽  
K. K. Lebedev ◽  
D. V. Samsonov ◽  
...  
Keyword(s):  
Pelvic Floor ◽  
Perineal Wound ◽  
Abdominoperineal Excision ◽  
Early Postoperative Period ◽  
Wound Complications ◽  
Pelvic Floor Reconstruction ◽  
Group Iii ◽  
Group I ◽  
Perineal Wound Complications ◽  
Group Ii

Background. Extralevator abdominoperineal excision is associated with a high incidence of perineal wound complications. There is no uniform standard for choosing the method for pelvic floor reconstruction after extralevator abdominoperineal excision.The purpose of the study was to compare the results of extralevator abdominoperineal excisions of the rectum using various methods of perineal wound closure.Materials and Methods. Between 2014 and 2018, 120 patients underwent extralevator abdominoperineal excisions of the rectum using various options for closure of the pelvic floor. The patients were divided into 3 groups. Group I patients (n=64) underwent simple plasty of the peritoneal wound. Group II patients (n=43) underwent myoplasty using the gluteus maximus muscle. Group III patients (n=13) underwent myoplasty using the rectus abdominis muscle. The incidence of perineal wound complications in the early postoperative period was assessed.Results. The total number of perineal wound complications in Group I, II and III was 33 (51.5 %), 13 (30.2 %), and 6 (46.1 %), respectively. Grade IIIA-IIIB complications according to the Clavien-Dindo classification were observed in 25 % of Group I patients, in 18.6 % of Group II patients and in 7.7 % of Group II patients. Postoperative perineal wound complications occurred more often in Group I patients after simple plasty than in Group II and III patients after myoplasty (51.5 % versus 30.2 %). However, perineal wound complications were observed more often in Group III than in Group II (46.1 % versus 30.2 %, respectively). No significant differences in the frequency of complications between 3 groups were found.Conclusion. Using various options for closure of the pelvic floor after extralevator abdominoperineal excisions of the rectum, there was a tendency to reduction in the incidence of grade IIIA-IIIB perineal wound complications.

scholarly journals Retrospective Analysis of Risk Factors for Postoperative Perineal Hernia After Endoscopic Abdominoperineal Excision for Rectal Cancer

2021 ◽  
Author(s):  
Tatsuya Manabe ◽  
Yusuke Mizuuchi ◽  
Yasuhiro Tsuru ◽  
Hiroshi Kitagawa ◽  
Takaaki Fujimoto ◽  
...  
Keyword(s):  
Risk Factors ◽  
Rectal Cancer ◽  
Regression Analysis ◽  
Odds Ratio ◽  
Open Surgery ◽  
Abdominoperineal Excision ◽  
Perineal Hernia ◽  
Lower Rectal Cancer ◽  
Peritoneal Closure ◽  
Initial Surgery

Abstract Background: In contrast to open-surgery abdominoperineal excision (APE) for rectal cancer, postoperative perineal hernia (PPH) is reported to increase after extralevator APE and endoscopic surgery. In this study, therefore, we aimed to determine the risk factors for PPH after endoscopic APE.Methods: A total 73 patients who underwent endoscopic APE for lower rectal cancer were collected from January 2009 to March 2020, and the risk factors for PPH were analyzed retrospectively.Results: Nineteen patients (26%) developed PPH after endoscopic APE, and the diagnosis of PPH was made at 9–393 days (median: 183 days) after initial surgery. Logistic regression analysis showed that absence of pelvic peritoneal closure alone increased the incidence of PPH significantly (odds ratio; 13.76, 95% confidence interval; 1.48–1884.84, p = 0.004).Conclusions: Pelvic peritoneal closure should be performed when possible after endoscopic APE to prevent PPH.

scholarly journals Multicentre, randomised trial comparing acellular porcine collagen implant versus gluteus maximus myocutaneous flap for reconstruction of the pelvic floor after extended abdominoperineal excision of rectum: study protocol for the Nordic Extended Abdominoperineal Excision (NEAPE) study

BMJ Open ◽  
2019 ◽  
Vol 9 (5) ◽  
pp. e027255 ◽  
Author(s):  
Martin Rutegård ◽  
Jörgen Rutegård ◽  
Markku M Haapamäki
Keyword(s):  
Rectal Cancer ◽  
Pelvic Floor ◽  
Myocutaneous Flap ◽  
Gluteus Maximus ◽  
Abdominoperineal Excision ◽  
Ethical Review ◽  
Reconstruction Method ◽  
Collagen Implant ◽  
Porcine Collagen ◽  
Gluteus Maximus Myocutaneous Flap

IntroductionDifferent surgical techniques are used to cover the defect in the floor of the lesser pelvis after an ‘extralevator’ or ‘extended’ abdominoperineal excision for advanced rectal cancer. However, these operations are potentially mutilating, and the reconstruction method of the pelvic floor has been studied only sparsely. We aim to study whether a porcine-collagen implant is superior or equally beneficial to a gluteus maximus myocutaneous flap as a reconstruction method.Methods and analysisThis is a multicentre non-blinded randomised controlled trial with the experimental arm using a porcine-collagen implant and the control arm using a gluteus maximus muscle and skin rotation flap. Considered for inclusion are patients with rectal cancer, who are operated on with a wide abdominoperineal rectal excision including most of the levator muscles and where the muscle remnants cannot be closed in the midline with sutures. Patients with a primary or recurrent rectal cancer with an estimated survival of more than a year are eligible. The randomisation is computer generated with a concealed sequence and stratified by participating hospital and preoperative radiotherapy regimen. The main outcome is physical performance 6 months after surgery measured with the timed-stands test. Secondary outcomes are perineal wound healing, surgical complications, quality of life, ability to sit and other outcomes measured at 3, 6 and 12 months after surgery. To be able to state experimental arm non-inferiority with a 10% margin of the primary outcome with 90% statistical power and assuming 10% attrition, we aim to enrol 85 patients from May 2011 onwards.Ethics and disseminationThe study has been approved by the Regional Ethical Review board at Umeå University (protocol no: NEAPE-2010-335-31M). The results will be disseminated through patient associations and conventional scientific channels.Trial registration numberNCT01347697; Pre-results.

scholarly journals Repair of Perineal Hernia Following Abdominoperineal Excision with Biological Mesh: A Systematic Review

2016 ◽  
Vol 3 ◽  
Author(s):  
Sunil K. Narang ◽  
Nasra N. Alam ◽  
Ferdinand Köckerling ◽  
Ian R. Daniels ◽  
Neil J. Smart
Keyword(s):  
Systematic Review ◽  
Abdominoperineal Excision ◽  
Perineal Hernia ◽  
Biological Mesh

Pelvic floor reconstruction with bilateral gracilis flaps following extralevator abdominoperineal excision - a video vignette

2017 ◽  
Vol 19 (12) ◽  
pp. 1120-1121 ◽  
Author(s):  
C. S. Jones ◽  
J. Nowers ◽  
N. J. Smart ◽  
J. Coelho ◽  
A. Watts ◽  
...  
Keyword(s):  
Pelvic Floor ◽  
Abdominoperineal Excision ◽  
Pelvic Floor Reconstruction ◽  
Video Vignette
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