Biologic mesh reconstruction of the pelvic floor after extralevator abdominoperineal excision; a systematic review
IntroductionThe aim of this review is to provide an overview of the evidence for the use of biologic mesh in the reconstruction of the pelvic floor after extralevator abdominoperineal excision of the rectum (ELAPE).MethodsA systematic search of PubMed was conducted using the search terms ‘ELAPE’, ‘e...
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doaj-153c136e928f4f9e85e84c8af1f7d8312020-11-24T22:59:18ZengFrontiers Media S.A.Frontiers in Surgery2296-875X2016-02-01310.3389/fsurg.2016.00009163138Biologic mesh reconstruction of the pelvic floor after extralevator abdominoperineal excision; a systematic reviewNasra N Alam0Sunil K Narang1Ferdinand eKöckerling2Ian R Daniels3Neil J Smart4Royal Devon & Exeter HospitalRoyal Devon & Exeter HospitalDepartment of Surgery and Center for Minimally Invasive SurgeryRoyal Devon & Exeter HospitalRoyal Devon & Exeter HospitalIntroductionThe aim of this review is to provide an overview of the evidence for the use of biologic mesh in the reconstruction of the pelvic floor after extralevator abdominoperineal excision of the rectum (ELAPE).MethodsA systematic search of PubMed was conducted using the search terms ‘ELAPE’, ‘extralevator abdominoperineal excision of rectum’ or ‘extralevator abdominoperineal resection’. The search yielded 17 studies.ResultsBiologic mesh was used in perineal reconstruction in 463 cases. There were 41 perineal hernias reported but rates were not consistently reported in all studies. The most common complications were perineal wound infection (n = 93), perineal sinus and fistulae (n = 26) and perineal haematoma or seroma (n = 11). There were very few comparative studies, with only one RCT identified that compared patients undergoing ELAPE with perineal reconstruction using a biological mesh, with patients undergoing a conventional abdominoperineal excision of the rectum with no mesh. There was no significant difference in perineal hernia rates or perineal wound infections between the groups. Other comparative studies comparing the use of biologic mesh with techniques such as the use of myocutaneous flaps were of low quality.ConclusionsBiologic mesh-assisted perineal reconstruction is a promising technique to improve wound healing and has comparable complications rates to other techniques. However, there is not enough evidence to support its use in all patients who have undergone ELAPE. Results from high-quality prospective RCTs and national/international collaborative audits are required.http://journal.frontiersin.org/Journal/10.3389/fsurg.2016.00009/fullELAPEPelvic floor reconstructionBiological meshextralevator abdominoperineal excision of rectumextralevator abdominoperineal resection |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Nasra N Alam Sunil K Narang Ferdinand eKöckerling Ian R Daniels Neil J Smart |
spellingShingle |
Nasra N Alam Sunil K Narang Ferdinand eKöckerling Ian R Daniels Neil J Smart Biologic mesh reconstruction of the pelvic floor after extralevator abdominoperineal excision; a systematic review Frontiers in Surgery ELAPE Pelvic floor reconstruction Biological mesh extralevator abdominoperineal excision of rectum extralevator abdominoperineal resection |
author_facet |
Nasra N Alam Sunil K Narang Ferdinand eKöckerling Ian R Daniels Neil J Smart |
author_sort |
Nasra N Alam |
title |
Biologic mesh reconstruction of the pelvic floor after extralevator abdominoperineal excision; a systematic review |
title_short |
Biologic mesh reconstruction of the pelvic floor after extralevator abdominoperineal excision; a systematic review |
title_full |
Biologic mesh reconstruction of the pelvic floor after extralevator abdominoperineal excision; a systematic review |
title_fullStr |
Biologic mesh reconstruction of the pelvic floor after extralevator abdominoperineal excision; a systematic review |
title_full_unstemmed |
Biologic mesh reconstruction of the pelvic floor after extralevator abdominoperineal excision; a systematic review |
title_sort |
biologic mesh reconstruction of the pelvic floor after extralevator abdominoperineal excision; a systematic review |
publisher |
Frontiers Media S.A. |
series |
Frontiers in Surgery |
issn |
2296-875X |
publishDate |
2016-02-01 |
description |
IntroductionThe aim of this review is to provide an overview of the evidence for the use of biologic mesh in the reconstruction of the pelvic floor after extralevator abdominoperineal excision of the rectum (ELAPE).MethodsA systematic search of PubMed was conducted using the search terms ‘ELAPE’, ‘extralevator abdominoperineal excision of rectum’ or ‘extralevator abdominoperineal resection’. The search yielded 17 studies.ResultsBiologic mesh was used in perineal reconstruction in 463 cases. There were 41 perineal hernias reported but rates were not consistently reported in all studies. The most common complications were perineal wound infection (n = 93), perineal sinus and fistulae (n = 26) and perineal haematoma or seroma (n = 11). There were very few comparative studies, with only one RCT identified that compared patients undergoing ELAPE with perineal reconstruction using a biological mesh, with patients undergoing a conventional abdominoperineal excision of the rectum with no mesh. There was no significant difference in perineal hernia rates or perineal wound infections between the groups. Other comparative studies comparing the use of biologic mesh with techniques such as the use of myocutaneous flaps were of low quality.ConclusionsBiologic mesh-assisted perineal reconstruction is a promising technique to improve wound healing and has comparable complications rates to other techniques. However, there is not enough evidence to support its use in all patients who have undergone ELAPE. Results from high-quality prospective RCTs and national/international collaborative audits are required. |
topic |
ELAPE Pelvic floor reconstruction Biological mesh extralevator abdominoperineal excision of rectum extralevator abdominoperineal resection |
url |
http://journal.frontiersin.org/Journal/10.3389/fsurg.2016.00009/full |
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