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Long-term outcomes of biological mesh repair following extra levator abdominoperineal excision of the rectum: an observational study of 100 patients

Thomas, P. W.; Blackwell, J. E. M.; Herrod, P. J. J.; Peacock, O.; Singh, R.; Williams, J. P.; Hurst, N. G.; Speake, W. J.; Bhalla, A.; Lund, J. N.


P. W. Thomas

J. E. M. Blackwell

P. J. J. Herrod

O. Peacock

R. Singh

Clinical Associate Professor

N. G. Hurst

W. J. Speake

A. Bhalla


Current evidence suggests that pelvic floor reconstruction following extralevator abdominoperineal excision of rectum (ELAPER) may reduce the risk of perineal herniation of intra-abdominal contents. Options for reconstruction include mesh and myocutaneous flaps, for which long-term follow-up data is lacking. The aim of this study was to evaluate the long-term outcomes of biological mesh (Surgisis®, Biodesign™) reconstruction following ELAPER.

A retrospective review of all patients having ELAPER in a single institution between 2008 and 2018 was perfomed. Clinic letters were scrutinised for wound complications and all available cross sectional imaging was reviewed to identify evidence of perineal herniation (defined as presence of intra-abdominal content below a line between the coccyx and the lower margin of the pubic symphysis on sagittal view).

One hundred patients were identified (median age 66, IQR 59–72 years, 70% male). Median length of follow-up was 4.9 years (IQR 2.3–6.7 years). One, 2- and 5-year mortality rates were 3, 8 and 12%, respectively. Thirty three perineal wounds had not healed by 1 month, but no mesh was infected and no mesh needed to be removed. Only one patient developed a symptomatic perineal hernia requiring repair. On review of imaging a further 7 asymptomatic perineal hernias were detected. At 4 years the cumulative radiologically detected perineal hernia rate was 8%.

This study demonstrates that pelvic floor reconstruction using biological mesh following ELAPER is both safe and effective as a long-term solution, with low major complication rates. Symptomatic perineal herniation is rare following mesh reconstruction, but may develop sub clinically and be detectable on cross-sectional imaging.


Thomas, P. W., Blackwell, J. E. M., Herrod, P. J. J., Peacock, O., Singh, R., Williams, J. P., …Lund, J. N. (2019). Long-term outcomes of biological mesh repair following extra levator abdominoperineal excision of the rectum: an observational study of 100 patients. Techniques in Coloproctology, 23(8), 761-767.

Journal Article Type Article
Acceptance Date Jul 29, 2019
Online Publication Date Aug 7, 2019
Publication Date Aug 7, 2019
Deposit Date Aug 9, 2019
Publicly Available Date Aug 9, 2019
Journal Techniques in Coloproctology
Print ISSN 1123-6337
Electronic ISSN 1128-045X
Publisher Springer Nature
Peer Reviewed Peer Reviewed
Volume 23
Issue 8
Pages 761-767
Keywords Abdominoperineal excision; Surgical mesh; Rectal cancer; Hernia
Public URL
Publisher URL


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