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

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.

1. Han G.J., Wang Z.J., Wei G.H., Gao Z.G., Yang Y., ZhaoB.C. Randomized clinical trial of conventional versus cylindrical abdominoperineal resection for locally advanced lower rectal cancer. Am J Surg. 2012 Sep; 204 (3): 274-82. doi: 10.1016/j.amjsurg.2012.05.001.

2. Holm T. Controversiesin Abdominoperineal Excision. Surg Oncol Clin N Am. 2014 Jan; 23 (1): 93-111. doi: 10.1016/j.soc.2013.09.005

3. ColovE.P.,KleinM., GogenurI. Wound Complications and Perineal Pain After Extralevator Versus Standard Abdominoperineal Excision: A Nationwide Study. Dis Colon Rectum. 2016 Sep; 59 (9): 813-21. doi: 10.1097/DCR.0000000000000639.

4. Devulapalli C., Jia Wei A.T., DiBiagio J.R., Baez M.L., Baltoda-noP.A., Seal S.M., Sacks J.M., Cooney C.M., Rosson G.D. Primary versus Flap Closure of Perineal Defects following Oncologic Resection: A Systematic Review and Meta-Analysis. Plast Reconstr Surg. 2016 May; 137 (5): 1602-13. doi: 10.1097/PRS.0000000000002107.Review.

5. Musters G.D., Klaver C.E.L., Bosker R.J.I., Burger J.W.A., van Duijvendijk P., van Etten B., van Geloven A.A.W., de Graaf E.J.R., Hoff C., Leijtens J.W.A., Rutten H.J.T., Singh B, Vuylsteke R.J.C.L.M., de Wilt J.H.W., Dijkgraaf M.G.W., Bemelman W.A., Tanis P.J. Biological

6. Mesh Closure of the Pelvic Floor After Extralevator Abdominoperineal Resection for Rectal Cancer. Ann Surg. Jun 2017; 265 (6): 1074-81. doi:10.1097/sla.0000000000002020.

7. Holm T., Ljung A., Haggmark T., Jurell G., Lagergren J. Extended abdominoperineal resection with gluteus maximus flap reconstruction of the pelvic floor for rectal cancer. Br J Surg. 2007 Feb; 94 (2), 232-238. doi:10.1002/bjs.5489

8. Pang J., Broyles J.M., Berli J., Buretta K., Shridharani S.M., Roch-linD.H., Efron J.E., Sacks JM. Abdominal-Versus Thigh-Based Reconstruction of Perineal Defects in Patients With Cancer. Dis Colon Rectum. 2014 Jun; 57 (6): 725-732. doi: 10.1097/DCR.0000000000000103.

9. Butt H.Z., Salem M.K., Vijaynagar B., Chaudhri S., Singh, B. Perineal reconstruction after extra-levator abdominoperineal excision (eLAPE): a systematic review. Int J Colorectal Dis. 2013 Nov; 28 (11): 1459-68. doi: 10.1007/s00384-013-1660-6.

10. McMenaminD., ClementsD., Edwards T., FittonA., Douie W. Rectus abdominis myocutaneous flaps for perineal reconstruction: modifications to the technique based on a large single-centre experience. Ann R Coll Surg Engl. 2011 Jul; 93 (5): 375-81. doi: 10.1308/003588411X572268.