title: Biological mesh reconstruction of perineal wounds following enhanced abdominoperineal excision of rectum (APER).
abstract: BACKGROUND
  An abdominoperineal excision of rectum (APER) may be required for rectal tumours less than 6 cm from the anal verge. Recently, the cylindrical APER has been used to prevent the "surgical waist" and so decrease margin involvement. However, removal of the levators leaves a large defect. Myocutaneous flaps [e.g. vertical rectus abdominis (VRAM)] are often used to fill the cylindrical resection defect, but have disadvantages associated with operative time, expertise and morbidity. We report our early experience of pelvic floor reconstruction with a biological mesh following cylindrical APER.
  
  
  METHODS
  Data on consecutive patients having cylindrical APER between January 2008 and November 2010 were collected. Outcomes were compared between a VRAM reconstruction group and a mesh group.
  
  
  RESULTS
  In 15 consecutive patients with low rectal cancer, five patients had VRAM pelvic floor reconstruction prior to ten patients having biosynthetic mesh repairs. The median operative time for the VRAM cohort was 405 min, compared with 259 min for the mesh (p = 0.0013). The median length of postoperative stay was 20 days for VRAM and 10 days for the mesh group (p = 0.067). There were four early complications for the VRAM group compared with seven for the mesh cohort (p = 0.37). The median cost per patient for the VRAM cohort was £11,075 compared to a median cost of £6,513 for the Mesh (p = 0.0097).
  
  
  CONCLUSIONS
  The use of a biological mesh for pelvic floor reconstruction following cylindrical APER is feasible with morbidity comparable to VRAM reconstruction. There is significant cost-saving using a biosynthetic mesh, mainly due to reduced length of stay.
authors: Graduate Entry School of Medicine and Health, Division of Surgery, Royal Derby Hospital, University of Nottingham, Uttoxeter Road, Derby, DE22 3DT, UK. oliver.peacock@nhs.net
authors: Oliver
authors: O
authors: Peacock
authors: H
authors: H
authors: Pandya
authors: T
authors: T
authors: Sharp
authors: N G
authors: NG
authors: Hurst
authors: W J
authors: WJ
authors: Speake
authors: G M
authors: GM
authors: Tierney
authors: J N
authors: JN
authors: Lund
mesh_terms: D000005:Abdomen / Q000601:surgery*; D000368:Aged; D003365:Costs and Cost Analysis; D003710:Demography; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010502:Perineum / Q000473:pathology* / Q000601:surgery*; D011182:Postoperative Care / Q000191:economics; D011183:Postoperative Complications / Q000209:etiology; D019651:Plastic Surgery Procedures / Q000191:economics / Q000379:methods*; D012007:Rectum / Q000601:surgery*; D013526:Surgical Mesh / Q000191:economics; D013997:Time Factors; D014945:Wound Healing