title: Pelvic floor reconstruction with a biological mesh after extralevator abdominoperineal excision leads to few perineal hernias and acceptable wound complication rates with minor movement limitations: single-centre experience including clinical examination and interview.
abstract: OBJECTIVE
  The aim of the study was to describe long-term subjective and objective results of pelvic floor reconstruction using an absorbable biological mesh after extralevator abdominoperineal excision (ELAPE) for low rectal cancer.
  
  
  METHODS
  Records of 53 patients who had an ELAPE with reconstruction of the pelvic floor with a Permacol® mesh between August 2007 and August 2011 were reviewed. Thirty-one of the patients were called for interview and clinical examination.
  
  
  RESULTS
  Three (6%) patients developed perineal hernia, 11 had fistulae (nine of which were treated successfully), four patients had a perineal abscess and four patients had superficial wound infections. Removal of the mesh was necessary in one case, while another patient needed implantation of a new mesh. In 13 of the 31 interviewed patients, long-term pain was present, but resolved after a median of 8 months (3-56). No major sitting or movement disabilities were encountered. Three-year survival was 82%, and no local recurrences were found.
  
  
  CONCLUSIONS
  Pelvic floor reconstruction with a biological mesh is a feasible solution when performing ELAPE for low rectal cancer, although long-term pain is a frequent complication.
authors.affiliation: Digestive Disease Center, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark.
authors.forename: K K
authors.initials: KK
authors.lastname: Jensen
authors.forename: L
authors.initials: L
authors.lastname: Rashid
authors.forename: B
authors.initials: B
authors.lastname: Pilsgaard
authors.forename: P
authors.initials: P
authors.lastname: Møller
authors.forename: P
authors.initials: P
authors.lastname: Wille-Jørgensen
mesh_terms: D000038:Abscess; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001672:Biocompatible Materials / Q000627:therapeutic use*; D059350:Chronic Pain; D015331:Cohort Studies; D003094:Collagen / Q000627:therapeutic use*; D017577:Cutaneous Fistula; D005260:Female; D006547:Hernia; D006801:Humans; D008297:Male; D008875:Middle Aged; D017773:Pelvic Floor / Q000601:surgery*; D010502:Perineum; D011183:Postoperative Complications; D012004:Rectal Neoplasms / Q000601:surgery*; D012189:Retrospective Studies; D013526:Surgical Mesh; D013530:Surgical Wound Infection; D016896:Treatment Outcome
chemical_list: D001672:Biocompatible Materials; C422414:Permacol; D003094:Collagen
keywords: Abdominoperineal excision; biological mesh; pelvic floor reconstruction; postoperative complications