Abstract
Background: The purpose was to analyze the casuistry of pelvic floor reconstruction (PFR) with biological mesh (BM) after exenterative radical surgery. Methods: Six patients treated with radical surgery and reconstruction of the perineal defect, conducted with a BM, since April 2011 to June 2016, are described. Results: A total of 5 pelvic exenterations and an anterior pelvic supralevator exenteration were performed, 2 cases included a radical vulvectomy. In 5 patients the BM was placed intraoperatively, combined with myocutaneous bilateral gracilis flap or omentoplasty. Another case required deferred mesh placement due to evisceration through the perineal hole. Mean surgical time was 510 minutes and a median hospitalization of 26 days. Complications were mainly due to infections and abdominal wall dehiscence. There were no pelvic organ prolapses and no mesh had to be removed. The mean follow-up was 8.5 months; halfof the patients are free of disease. Conclusion: Though limited evidence, BM can be a safe and feasible option in cases of radical surgical gynecological procedures with a wide loss of soft tissue. More data is required.
Highlights
Materials and MethodsAbdominoperineal radical surgery in advanced or relapsed gynecological cancer produces a large perineal defect, requiring immediate and a complex pelvic floor reconstruction (PFR)
The incidence of perineal prolapse is over 6% after an ultra-radical surgery
Omentoplasty is considered an alternative, but not enough to cover large defects; and autologous flaps do not prevent from perineal prolapse; though many cases require the combination of both procedures [2]
Summary
Abdominoperineal radical surgery in advanced or relapsed gynecological cancer produces a large perineal defect, requiring immediate and a complex pelvic floor reconstruction (PFR). The empty pelvic dead space predisposes to abscesses, fistula, wound infection, bowel obstruction and perineal prolapse. The incidence of perineal prolapse is over 6% after an ultra-radical surgery. These complications are associated with increased hospital stay, reoperation, and low quality of life [1,2]. Current standards in PFR are myocutaneous flaps, alternatives are omentoplasty or breast implant. Omentoplasty is considered an alternative, but not enough to cover large defects; and autologous flaps do not prevent from perineal prolapse; though many cases require the combination of both procedures [2]
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