Perineal reconstruction after extralevator abdominoperineal
Perineal wound complications after extralevator abdominoperineal resection for cancer are common with no consensus on optimal reconstructive technique.

Researchers compared short- and long-term results of laparoscopic abdominoperineal resection with open surgery ± vertical rectus abdominis myocutaneous flap.

This is a single-institution retrospective observational study of 204 consecutive patients with advanced low rectal cancer who underwent extralevator abdominoperineal resection. The main outcome measures were short-term results, wound complications, and incisional, parastomal, and perineal hernia rates.

Fifty-five patients had a laparoscopic approach, 80 open, and 69 open + vertical rectus abdominis myocutaneous flap. The groups had a similar median length of follow-up. Patients’ age and radiation, intraoperative and postoperative complications, mortality, and readmission rates were similar among the 3 groups.

- Perineal wound infection and dehiscence rates were not influenced by the surgical approach.

- Laparoscopy resulted in higher perineal and parastomal hernia rates than did open or open + vertical rectus abdominis myocutaneous flap.

- Patients who underwent an open approach had a higher body mass index and rate of prior surgeries and preoperative ostomies.

- Laparoscopic and open approaches had significantly shorter operative times and shorter lengths of stay than open with a flap approach.

Open and open + vertical rectus abdominis myocutaneous flap approaches for reconstruction after abdominoperineal resection had lower parastomal and perineal hernias rates but similar postoperative morbidity as did the laparoscopic approach.