Biological mesh reconstruction of the pelvic floor following abdominoperineal excision for cancer: A review

Abstract

Extralevator abdominoperineal excision and pelvic exenteration are mutilating operations that leave wide perineal wounds. Such large wounds are prone to infection and perineal herniation, and their closure is a major concern to most surgeons. Different approaches to the perineal repair exist, varying from primary or mesh closure to myocutaneous flaps. Each technique has its own associated advantages and potential complications and the ideal approach is still debated. In the present study, we reviewed the current literature and our own local data regarding the use of biological mesh for perineal wound closure. Current evidence suggests that the use of biological mesh carries an acceptable risk of wound complications compared to primary closure and is similar to flap reconstruction. In addition, the rate of perineal hernia is lower in early follow-up, while long-term hernia occurrence appears to be similar between the different techniques. Finally, it is an easy and quick reconstruction method. Although more expensive than primary closure, the cost associated with the use of a biological mesh is at least equal, if not less, than flap reconstruction.

Keywords: Biological mesh; Rectal cancer; Pelvic exenteration; Abdominoperineal resection; Primary perineal wound closure; Perineal wound infection; Perineal hernia

Core tip: Current literature regarding the use of biological mesh reconstruction after pelvic exenteration and extralevator abdominoperineal excision is scarce. However, it does suggest that the use of biological mesh has a lower short-term perineal hernia rate, but is probably not superior to other approaches with regards to perineal wound complications.