Gastrointestinal Oncology

Annals of Surgical Oncology

, Volume 19, Issue 2, pp 502-503

First online:

Laparoscopic Abdominoperineal Resection with Open Posterior Cylindrical Excision and Primary Transpelvic VRAM Flap

  • R. E. HorchAffiliated withDepartment of Plastic and Hand Surgery, University of Erlangen Medical Center Email author 
  • , A. D’HooreAffiliated withDepartment of Abdominal Surgery, University Clinics Gasthuisberg
  • , T. HolmAffiliated withSection of Coloproctology, Department of Surgery, Karolinska University Hospital
  • , U. KneserAffiliated withDepartment of Plastic and Hand Surgery, University of Erlangen Medical Center
  • , W. HohenbergerAffiliated withDepartment of General and Visceral Surgery, University Hospital Erlangen, Friedrich-Alexander Universität Erlangen-Nürnberg
  • , A. ArkudasAffiliated withDepartment of Plastic and Hand Surgery, University of Erlangen Medical Center

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Abstract

Background

In our own experience over the last 15 years, the primary transpelvic vertical rectus abdominis myocutaneous (VRAM) flap is a reliable tool to prevent perineal wound complications after cylindrical excision in radical anorectal tumor surgery. To minimize the operative trauma in such patients, we performed a laparoscopic abdominoperineal resection combined with an open posterior cylindrical excision and a primary transpelvic vertical rectus abdominis myocutaneous (VRAM) flap via a minimal supraumbilical incision, which is described here for the first time.

Methods

A 49-year-old patient with recurrent anal cancer received radiochemotherapy with curative intention and underwent laparoscopic abdominoperineal rectal excision with posterior cylindrical excision combined with a primary transpelvic vertical rectus abdominis myocutaneous (VRAM) flap. The rectal stump was clipped and pulled through the pelvis together with the VRAM flap, which was then placed into the sacral defect.

Results

We found that the combined operative technical approaches with laparoscopy and minimal incisions for flap harvest and cylindrical excision were technically feasible, and no mesh was needed to close the small-sized laparotomies. We achieved complete tumor removal and flap perfusion, and healing was uneventful. The patient showed no relapse at 3 years postoperative.

Conclusions

Our report of the operative technique shows that the combination of minimally invasive methods together with transpelvic VRAM flap transposition is technically feasible, can be performed with operative efficiency, and may become a valuable tool to minimize perioperative complications in advanced colorectal tumor surgery.