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Colorectal Disease : the Official... Nov 2022
Meta-Analysis
Topics: Humans; Surgical Mesh; Neoplasm Recurrence, Local; Hernia, Abdominal; Proctectomy; Surgical Flaps
PubMed: 36426619
DOI: 10.1111/codi.16386 -
Surgery Mar 2021Surgery for low rectal cancer can be associated with severe bowel dysfunction and impaired quality of life. It is important to determine how patients value the trade-off...
BACKGROUND
Surgery for low rectal cancer can be associated with severe bowel dysfunction and impaired quality of life. It is important to determine how patients value the trade-off between anorectal dysfunction versus abdominoperineal resection. Therefore, the objective was to determine patients' preferences for treatment for low rectal cancer.
METHODS
Ambulatory patients without colorectal cancer at a single high-volume academic colorectal referral center from September 2019 to March 2020 were included. Patients with prior stoma or malignancy were excluded. Participants were presented with a hypothetic scenario describing a low rectal cancer. A threshold task identified preferences for functional and oncologic outcomes for sphincter preservation versus abdominoperineal resection.
RESULTS
A total of 123 patients were recruited. Patients preferred abdominoperineal resection over sphincter preservation if there were more than a mean of 6.7 (standard deviation 4.0) daily bowel movements, 1.9 (standard deviation 2.6) daily episodes of stool incontinence, and 6.5 (standard deviation 3.2) gas incontinence. Abdominoperineal resection was preferred over sphincter preservation in 38% if daily activities were altered owing to fecal urgency. Patients were willing to accept a 10% (interquartile range, 5-25) absolute increase in risk of margin involvement with sphincter preservation to avoid abdominoperineal resection. Abdominoperineal resection was the preferred option overall for 18% of patients.
CONCLUSION
An important proportion of patients would prefer abdominoperineal resection over sphincter preservation owing to the impairments in anorectal function associated with sphincter preservation. The decision to perform sphincter preservation or abdominoperineal resection should consider how the patients' value functional outcomes with a low anastomosis.
Topics: Adult; Aged; Anal Canal; Fecal Incontinence; Female; Humans; Male; Middle Aged; Organ Sparing Treatments; Patient Preference; Proctectomy; Rectal Neoplasms
PubMed: 32854970
DOI: 10.1016/j.surg.2020.07.020 -
Asian Journal of Endoscopic Surgery Apr 2022Perineal hernia is the protrusion of the intra-abdominal viscera through the pelvic floor. It rarely occurs after abdominoperineal resection but has increasingly... (Review)
Review
Perineal hernia is the protrusion of the intra-abdominal viscera through the pelvic floor. It rarely occurs after abdominoperineal resection but has increasingly occurred after surgical treatment for rectal cancer. A patient was diagnosed as having perineal hernia 10 days after laparoscopic abdominoperineal resection with preoperative radiotherapy and chemotherapy. He presented with epigastric discomfort and perineal wound dehiscence. Perineal hernia was confirmed by computed tomography scan and treated with a semi-emergency surgery. The surgical field was contaminated because of the perineal wound dehiscence. The levator muscle at the pelvic floor was not sufficient, so we used a bladder patch to cover the pelvic inlet. The surgery was performed without any adverse events. To our best knowledge, this is the first case report to present the usefulness of a bladder patch for the treatment of a perineal hernia using a laparoscopic transabdominal approach in emergency situations.
Topics: Hernia; Hernia, Abdominal; Herniorrhaphy; Humans; Male; Perineum; Proctectomy; Rectal Neoplasms; Surgical Mesh; Urinary Bladder
PubMed: 34751003
DOI: 10.1111/ases.13011 -
The International Journal of Medical... Apr 2020Laparoscopic abdominoperineal resection (APR) for low rectal cancers is technically demanding. Robotic assistance may be of help and can be hybrid (HAPR) or totally... (Comparative Study)
Comparative Study
INTRODUCTION
Laparoscopic abdominoperineal resection (APR) for low rectal cancers is technically demanding. Robotic assistance may be of help and can be hybrid (HAPR) or totally robotic (RAPR). The present study describes outcomes of robotic APR and compares both approaches.
MATERIAL AND METHODS
A multicentric retrospective analysis of rectal cancer patients undergoing either HAPR or RAPR was conducted. Patients' demographics, surgeons' experience, oncologic results, and intraoperative and postoperative outcomes were collected.
RESULTS
One hundred twenty-five patients were included, 48 in HAPR group and 77 in RAPR group. Demographics and comorbidities were comparable. Operative time was reduced in RAPR group (266.9 ± 107.8 min vs 318.9 ± 75.1 min, P = .001). RAPR patients were discharged home more frequently (91.18% vs 66.67%, P = .001), and experienced fewer parastomal hernias (3.71% vs 9.86%, P = .001).
CONCLUSION
RAPR is safe and feasible with appropriate oncologic outcomes. Totally robotic approach reduces operative time and may improve functional outcomes.
Topics: Aged; Equipment Design; Female; Humans; Intraoperative Period; Laparoscopy; Male; Middle Aged; Operative Time; Postoperative Complications; Postoperative Period; Proctectomy; Rectal Neoplasms; Retrospective Studies; Robotic Surgical Procedures; Treatment Outcome; United States
PubMed: 31876089
DOI: 10.1002/rcs.2073 -
Diseases of the Colon and Rectum Aug 2023
Laparoscopic Abdominoperineal Resection With En Bloc Vaginal Resection and Immediate Neovaginal Reconstruction With Colonic Flap and Pelvic Floor Reconstruction With Mucosa-Removed Colonic Flap.
Topics: Female; Humans; Pelvic Floor; Surgical Flaps; Laparoscopy; Proctectomy; Mucous Membrane; Perineum; Rectal Neoplasms
PubMed: 37235861
DOI: 10.1097/DCR.0000000000002645 -
South African Journal of Surgery.... Sep 2020Extra-levator abdominoperineal resection (ELAPE) performed in the prone jack-knife position is a new technique in the developing world. Literature on the outcomes of...
BACKGROUND
Extra-levator abdominoperineal resection (ELAPE) performed in the prone jack-knife position is a new technique in the developing world. Literature on the outcomes of ELAPE in a developing country context is scarce. The objective was to assess early outcomes after ELAPE in the prone jack-knife position, and to compare outcomes of patients who underwent the abdominal part of the procedure performed laparoscopically with an open group, at a tertiary institution in Cape Town.
METHODS
Records of patients who underwent ELAPE for rectal adenocarcinoma from February 2011 to February 2017 at Tygerberg Hospital were retrospectively reviewed. Variables of interest included staging, rate of circumferential resection margin involvement (CRMI), intraoperative tumour perforation (IOP), perineal wound complications, early postoperative morbidity, length of intensive care unit (ICU) stay, duration of postoperative hospital stay and 30-day mortality rate.
RESULTS
52 patients (median age: 59 years) were included in the analysis. CRMI was evident in 16% (8/49) of patients and IOP in 6% (3/52). Perineal wound complications occurred in 32% (16/50) of patients. Median length of ICU and postoperative hospital stay was 3 days and 7 days, respectively. Overall morbidity was 47% (24/51) and the 30-day mortality rate was 3% (2/52). A significant difference in length of hospital stay was evident between the open and laparoscopic groups (11.5 days vs 6 days).
CONCLUSION
Prone abdominoperineal resection (APR), ELAPE, and laparoscopic ELAPE are acceptable and feasible procedures for patients with rectal cancer in the developing world, with outcomes being comparable to those determined in the developed world.
Topics: Adenocarcinoma; Adult; Aged; Aged, 80 and over; Female; Humans; Laparoscopy; Male; Middle Aged; Patient Positioning; Proctectomy; Prone Position; Rectal Neoplasms; Retrospective Studies; South Africa; Treatment Outcome
PubMed: 33231009
DOI: No ID Found -
Hernia : the Journal of Hernias and... Oct 2022Perineal hernia (PH) following abdominoperineal resection (APR) is a rare but challenging problem. Although different techniques have been described in literature, the...
PURPOSE
Perineal hernia (PH) following abdominoperineal resection (APR) is a rare but challenging problem. Although different techniques have been described in literature, the recurrence rate is still remarkable, and there is no consensus regarding the optimal repair approach. In the present study, we reported our experience based on a consecutive series of ten cases.
METHODS
Ten symptomatic large perineal hernias were repaired exclusively with the same laparoscopic-perineal dual fixation technique. Key steps consist laparoscopic adhesiolysis, hernia contents reduction, open excess perineal hernia sac resection, and mesh placement and dual fixation. Frist, a coated mesh was fixed to the sacrum and pelvic sidewalls with the metallic tacks in the laparoscopic step, second, the mesh was fixed anteriorly to urogenital diaphragm and laterally to the sacrotuberous ligament with permanent sutures in the perineal step.
RESULTS
Ten symptomatic PHs were repaired by the same laparoscopic-perineal dual fixation technique, 6 males and 4 females, median age at the time of repair was 69.5 years (range 66-77 years), the BMI was 24 ± 1. Four concomitant procedures were performed, including bilateral inguinal hernia repair with the transabdominal preperitoneal repair (TAPP) in one case, and laparoscopic parastomal hernia repair in two patients. The average operative time was 171 ± 45 min; the postoperative average hospital stay was 14 ± 4 days. There was no perineal hernia recurrence during the follow-up period (the median follow-up was 42 months; range 1-63 months).
CONCLUSION
Perineal hernia after APR is a rare and challenging postoperative complication, although many different approaches have been described, the recurrence is still high and the best method cannot be drawn. The present laparoscopic-perineal dual fixation approach proved to be a reproducible, effective and durable technique, and gave excellent results during the medium-long-term follow-up.
Topics: Aged; Female; Hernia; Hernia, Abdominal; Herniorrhaphy; Humans; Laparoscopy; Male; Proctectomy; Surgical Mesh
PubMed: 35652965
DOI: 10.1007/s10029-022-02632-8 -
Asian Journal of Endoscopic Surgery Oct 2022
Review
Topics: Hernia; Hernia, Abdominal; Herniorrhaphy; Humans; Neoplasm Recurrence, Local; Perineum; Postoperative Complications; Proctectomy; Rectal Neoplasms; Surgical Mesh; Urinary Bladder
PubMed: 35595265
DOI: 10.1111/ases.13082 -
International Journal of Surgery... Jul 2023
Meta-Analysis
How to reasonably deal with zero-events in meta-analysis of surgery-related outcomes? Oncologic outcomes of intersphincteric resection vs. abdominoperineal resection for lower rectal cancer: a systematic review and meta-analysis.
Topics: Humans; Rectal Neoplasms; Proctectomy; Treatment Outcome; Anal Canal
PubMed: 37300885
DOI: 10.1097/JS9.0000000000000379 -
Gan To Kagaku Ryoho. Cancer &... Dec 2022Perineal wound complications(PWCs)are common after abdominoperineal resection(APR). We examined the incidence of PWCs after APR for anorectal lesions and their risk...
BACKGROUND
Perineal wound complications(PWCs)are common after abdominoperineal resection(APR). We examined the incidence of PWCs after APR for anorectal lesions and their risk factors.
METHODS
Patients who underwent APR for anorectal lesions at our hospital from January 2011 to December 2021 were included. Complications of Clavien-Dindo Grade Ⅱ or higher were considered as PWCs.
RESULTS
Eighty-one patients were included; PWCs were observed in 24 patients (29.6%), and associated with a history of Crohn's disease(p=0.018), longer operation time(p=0.040), higher blood loss (p=0.011), extensive perineal resection(p=0.003), and closure with a skin flap(p=0.003). Forty-one patients underwent APR for initial rectal cancer without extended perineal resection, and PWCs were observed in 9 patients(22.0%). Prognostic nutritional index(PNI)<45(p=0.049), smoking(p=0.034), and alcohol consumption(p=0.021)were associated with PWCs.
CONCLUSION
We examined the incidence of PWCs after APR for anorectal lesions and their risk factors. Appropriate intervention in nutrition, smoking, and alcohol consumption may prevent PWCs.
Topics: Humans; Surgical Flaps; Rectal Neoplasms; Plastic Surgery Procedures; Crohn Disease; Proctectomy; Perineum; Postoperative Complications; Retrospective Studies
PubMed: 36733046
DOI: No ID Found