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PWE-300 Perineal wound complications in the era of extralevator abdominoperineal excision of the rectum (elape)
  1. C Mann,
  2. E Bown,
  3. D Couch,
  4. S Bhandari,
  5. K Boyle
  1. Department of Colorectal Surgery, University Hospitals of Leicester, Leicester, UK

Abstract

Introduction ELAPE is associated with improved oncological outcome compared to traditional abdominoperineal excision of the rectum (APER) and has become the standard surgical technique for low rectal cancers in many centres. It is however associated with large perineal defect, encouraging some surgeons to routinely reconstruct the pelvic floor using a mesh, and may be associated with high rates of wound morbidity. The aim of study was to review the rate of perineal wound complications following ELAPE in our centre.

Method All patients undergoing ELAPE for adenocarcinoma of the rectum at Leicester Royal Infirmary between January 2010 and September 2014 were identified from the prospectively maintained colorectal MDT database. Patient notes and computer records were reviewed to obtain data on the perineal closure technique and perineal wound complications, specifically wound breakdown and symptomatic perineal herniation.

Results 71 patients were included in the study - 38 were male, with a median age of 71 (range 46–88) years. Eighty-nine percent underwent pre-operative long-course chemoradiotherapy. R0resection was achieved in 96%. Sixty-eight patients underwent primary perineal wound closure including omentoplasty where possible; biological mesh was used in 1 patient and 2 underwent myocutaneous flap reconstruction. Thirty-nine percent of patients developed a perineal wound complication, with 13 percent developing a deep infection associated with wound breakdown–of these 69% required surgical intervention/Vac therapy. Three patients developed a late perineal sinuses. A symptomatic perineal hernia developed in four patients (5.6%), three of whom opted for conservative management; one is currently awaiting surgical repair.

Conclusion This is a large single centre series of ELAPE with good R0resection rates. ELAPE remains associated with high rates of perineal wound morbidity. We feel that the symptomatic perineal hernia rate is not high enough to justify routine use of biological mesh, and therefore a pragmatic approach to perineal reconstruction should be taken on individual patient basis, depending on tumour size and patient anatomy.

Disclosure of interest None Declared.

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