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PWE-391 Post-operative complications following extra-levator abdominoperineal excision (elape): a retrospective audit
  1. LC Ewan,
  2. S Shaw,
  3. S Rai
  1. Colorectal Surgery, Stepping Hill Hospital, Stockport, UK

Abstract

Introduction To determine the nature and frequency of general and perineal wound complications following ELAPE using biological mesh reconstruction of the pelvic floor.

Method This single-centre retrospective audit included 14 consecutive patients from Nov 2012 to Sept 2014. All patients underwent ELAPE for low rectal tumours and had primary pelvic floor reconstruction using Strattice biological mesh. Data collected included tumour staging, neoadjuvant chemoradiotherapy and post-operative complications.

Results 14 patients included (M:F ratio 4:1) had a mean age of 65yrs (47–83yrs). All received long-course (n = 12) or short-course (n = 2) radiotherapy. Post-op resection margins were R0 (n = 13) and R2 in 1 case. Tumours were staged at T1 (n = 3), T2 (n = 6) or T3 (n = 5) prior to radiotherapy. General complications included one death due to a urethral injury and subsequent urosepsis. Two patients developed post-operative ileus, one requiring TPN. There were 3 abdominal wound infections treated at the bedside. 12 perineal wounds healed without surgical or radiological intervention with any complications being treated on an outpatient basis. A pelvic collection required percutaneous drainage and 2 superficial wound infections were treated with antibiotics. Wound dehiscence occurred in 6 patients (3 superficial without infection, 1 superficial with infection, 1complete dehiscence with infection and1due to ureto-cutaneous fistula). Chronic perineal pain developed in 1 patient. 5 patients had no perineal wound complications.

Conclusion Overall 12 patients recovered well with no further intervention. Perineal wound complications were managed on an outpatient basis with no long-term problem with pelvic sepsis or wound healing. No mesh infections have been observed to date.

Disclosure of interest None Declared.

References

  1. Foster JD, Pathak S, Smart NJ, et al. Reconstruction of the perineum following extralevator abdominoperineal excision for carcinoma of the lower rectum: a systematic review. Colorectal Dis. 2012;14(9):1052–1059

  2. Biologics. 2014;8:83–90. Published online Mar 10, 2014. 10.2147/BTT. S46469PMCID: PMC3956623Porcine dermis implants in soft-tissue reconstruction: current status

  3. Selzner S, Koehler C, Stelzer J, Sims A, Witzigmann H. Extended abdominoperineal excision vs. standard abdomi- noperineal excision in rectal cancer—a systematic overview. Int J Colorectal Dis. 2011;26:1227–1240

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