A low incidence of perineal hernia when using a biological mesh after extralevator abdominoperineal excision with or without pelvic exenteration or distal sacral resection in locally advanced rectal cancer patients

Dijkstra, E., Kahmann, N. L. E., Hemmer, P., Havenga, K. & Etten, van, B., 8-Jun-2020, In : Techniques in Coloproctology. 24, p. 855-861 7 p.

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Background 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.
Methods 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.
Results 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.
Conclusions 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
Original languageEnglish
Pages (from-to)855-861
Number of pages7
JournalTechniques in Coloproctology
Publication statusE-pub ahead of print - 8-Jun-2020


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

ID: 128517537