We use porcine collagen to reconstruct the perineum following elAPE, and I am interested in other surgeons experience using materials in the pelvic floor.
I have seen in marseille doing rectus abdominis flap after apr. U can contact dr bernard lelong in paoli calmette
Hi,
I don't think there are long-term data on any biological meshes for any type of abdominal wall or perineal repair. Companies tend to be very vague about the fate of their products. I use the Cook Surgisys plug for anal fistula repair but I have doubts on it's long-term strength since it's supposedly replaced by native collagen within 3 months. I doubt any biological can match the strength of a syntehtic mesh and my guess is that it's long-term strength will be that of the patient's native collagen. I think Lars Pahlman of Uppsala uses or used Biological meshes for merineal recontruction after APRA a couple of years ago. He has probably data on his patients. Maybe check with him. Kind regards,
Charles de Gheldere
I don;t suppose it really matters if the repair is lap or open as the cylindrical excision leaves the same defect in both. Obviously, if you go to the trouble of doing the abdominal part laparoscopically, there's point then raising a rectus abdominis flap, with consequent pain, scar, quite high-tension closure etc.
We have for the past few years used a surgisis sheet sewn onto the pelvic side wall at the level of the excised levators. Results are good with no problems so far (see International journal of colorectal disease. 10/2011; 27(4):475-82 for early results, and no-one in this series or further cases has had any perineal problems). There will be breakdown of the superficial wound sometimes, probably because of radiotherapy, but also as has ever been the case after aper because of where the wound is (dependent and relatively dirty).
ps - theres a supplement with an article on this very subject in this month's Colorectal Disease.
The problem of perineal reconstruction arises upon wide excision of the pelvic floor in cylindrical excision APR.Sören Lauberg from Aarhus ( Denmark) presented in ESCP 2010 meeting in Copenhagen a series of 200 patients using collagen implants with very good results.At the moment there is an ongoing study in Sweden randomizing patients to reconstruction with either collagen implant or gluteal flap. The recruitment has been a bit sluggish but is picking up.Regarding rectus abdominis flaps they are best used when there is need of volume in the lower pelvis as in exenterations ( WJS 2010, 34 :2177-2184), in which case the long term results are excellent. The same flap using only the muscle in combination with mesh has been used successfully in the repair of a large perineal hernia after APR ( to be pubished )
Perineal hernias after aper were seen in about 8% patients. Omentopexy and soft tissue closure alone do not prevent perineal hernias. No Patient with pelvic floor reconstruction (flaps/mesh) developed perineal hernia. However incidence of wound infection and dehiscence ( p=ns) seemed higher after biological mesh.
PPT attached
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