ABSTRACT
PURPOSE: Abdominoperineal resection (APR) remains a key procedure for the treatment of low rectal/anorectal cancers. However, perineal wound closure remains challenging, particularly in extralevator abdominoperineal resection (ELAPR) due to gapped tissue planes. Different approaches have been attempted to improve perineal wound repair. The aim of this study is to report our 6-year experience in perineal wound closure utilising biological mesh. METHODS: We conducted a retrospective study using data from our prospectively maintained database, including patients who underwent APR with perineal mesh closure between 2016 and 2021. RESULTS: 49 patients underwent APR with perineal mesh reconstruction for low rectal cancer during the 6-year period. Of these, 63% were males, with a mean age of 68 (± 11), and a mean BMI of 27.9 (± 13.7). 49% (24) of patients received neoadjuvant therapy. 88% (43) of patients underwent standard "S-APR" and only 12% (6) underwent ELAPR. Majority of procedures were laparoscopic (87.8%) with conversion rate of 6.9%. Mean length of stay was 11.7 (± 11.6). The perineal wound infection rate was 30% and only two patient required mesh removal due to entero-cutaneous perineal fistula and pelvic abscess. Perineal hernia was found in only two patients (4.1%). CRM was negative in 81.6% of the patients. Mean follow-up period was 29.2 (± 16.5) months, and disease recurrence occurred in 9 (18.3%) patients with average number of months for recurrence of 21 (± 7). Overall survival during the follow-up period was 91%. CONCLUSION: Our series shows a favourable short- and medium-term outcome with routine insertion of mesh for perineal wound closure.
Subject(s)
Cutaneous Fistula , Proctectomy , Male , Humans , Aged , Female , Retrospective Studies , Surgical Mesh , Neoplasm Recurrence, Local , Neoadjuvant TherapyABSTRACT
Patients with hip arthrodeses are at risk of developing back pain or pain in other joints in the long term. Conversion to a total hip replacement or hip resurfacing leads to resolution of symptoms in most patients. We report a 40-year-old man who underwent conversion of a hip arthrodesis to hip resurfacing with good results.
Subject(s)
Arthrodesis/methods , Hip Joint/surgery , Osteoarthritis, Hip/surgery , Adult , Bone Screws , Humans , Male , Osteoarthritis, Hip/diagnosis , Reoperation , Surface PropertiesABSTRACT
BACKGROUND: Laparoscopic colorectal surgery has been reported to have some advantages compared with open surgery. The purpose of this study was to evaluate the incidence of incisional hernias after elective open colorectal resection versus laparoscopic colorectal resection. METHODS: The study group consisted of 104 patients who underwent elective colorectal resection or reversal of a Hartmann's procedure between November 2003 and March 2005. Baseline data were prospectively recorded on all patients. All were examined by an independent observer for evidence of incisional hernia after they had reached a minimum follow up of one year. RESULTS: At a median follow up of 22 (17-26) months, nine patients had died and 95 were reviewed. Of these, 32 underwent laparoscopic resection while 63 had open surgery. Patients were well matched for all baseline characteristics. The median length of the wound in the laparoscopic group was 9 cm (IQR: 8-11 cm) while in the open group it was 20.8 cm (IQR: 17-24 cm). There was no significant difference in incisional hernia rates between the groups (3 vs. 10, p = 0.52) or in those who had symptoms from their hernia (p = 0.773). CONCLUSIONS: Laparoscopic colorectal resection does not appear to reduce incisional hernia rates when compared with open surgery. Large randomised trials are required to confirm these findings.
Subject(s)
Colonoscopy/adverse effects , Colorectal Neoplasms/surgery , Hernia, Ventral/etiology , Laparotomy/adverse effects , Age Distribution , Aged , Aged, 80 and over , Chi-Square Distribution , Colectomy/adverse effects , Colectomy/methods , Colonoscopy/methods , Colorectal Neoplasms/mortality , Colorectal Neoplasms/pathology , Female , Follow-Up Studies , Hernia, Ventral/epidemiology , Humans , Incidence , Laparotomy/methods , Linear Models , Male , Postoperative Complications/epidemiology , Probability , Prospective Studies , Risk Assessment , Sensitivity and Specificity , Sex Distribution , Statistics, Nonparametric , Survival RateABSTRACT
Pelvic mesh slings are increasingly used to create abdomino-pelvic partitions. This procedure is usually safe and carries low morbidity and mortality rates. However, we report a case of a 60-year-old male with a history of an abdomino-perineal resection for a low rectal carcinoma followed by adjuvant radiotherapy, who presented with an entero-vesicle-cutaneous fistula as a result of the polypropylene mesh eroding into his small bowel. He had to have a total cystectomy, small bowel resection and mesh removal in order to alleviate his symptoms.
