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Meta-analysis of biological mesh reconstruction versus primary perineal closure after abdominoperineal excision of rectal cancer

International Journal of Colorectal Disease volume 36, pages 477–492 (2021)Cite this article

Abstract

Background

Extralevator abdominoperineal excision (ELAPE) of rectal cancer has been proposed to achieve better oncological outcomes. The resultant wide perineal wound, however, presents a challenge for primary closure and subsequent wound healing. This meta-analysis compared the outcomes of primary perineal closure with those of biological mesh reconstruction.

Methods

The Medline and Embase search was performed for the publications comparing primary perineal closure to biological mesh reconstruction. Early perineal wound complications (seroma, infection, dehiscence) and late perineal wound complications (perineal hernia, chronic pain, and chronic sinus) were analyzed as primary endpoints. Intraoperative blood loss, operation time, and hospital stay were compared as secondary endpoints.

Results

There was no significant difference in the overall early wound complications after primary closure or biological mesh reconstruction (odds ratio (OR) of 0.575 with 95% confidence interval (CI) of 0.241 to 1.373 and a P value of 0.213). The incidence of perineal hernia after 1 year was significantly high after primary closure of the perineal wounds (OR of 0.400 with 95% CI of 0.240 to 0.665 and a P value of 0.001). No significant differences were observed among other early and late perineal wound complications. The operation time and hospital stay were shorter after primary perineal closure (p 0.001).

Conclusion

A lower incidence of perineal hernia and comparable early perineal wound complications after biological mesh reconstruction show a relative superiority over primary closure. More randomized studies are required before a routine biological mesh reconstruction can be recommended for closure of perineal wounds after ELAPE.

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Author information

Affiliations

  1. Department of Surgery, University Hospital Limerick, St Nessan’s Rd, Dooradoyle, Co., Limerick, V94 F858, Republic of Ireland

    Nasir Zaheer Ahmad

  2. Department of Surgery, Russells Hall Hospital NHS Trust, Pensnett Rd, West Midlands, Dudley, DY1 2HQ, UK

    Muhammad Hasan Abbas

  3. Department of Colorectal Surgery, Hamad Medical Hospital, Doha, Qatar

    Noof Mohammed A. B. Al-Naimi

  4. Faculty of Health Sciences, University of Portsmouth, Portsmouth, UK

    Amjad Parvaiz

  5. Colorectal Department, Poole NHS Trust Poole UK, Poole, UK

    Amjad Parvaiz

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  1. Nasir Zaheer Ahmad
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  2. Muhammad Hasan Abbas
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  3. Noof Mohammed A. B. Al-Naimi
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Zaheer Ahmad, N., Abbas, M.H., Al-Naimi, N.M.A.B. et al. Meta-analysis of biological mesh reconstruction versus primary perineal closure after abdominoperineal excision of rectal cancer. Int J Colorectal Dis 36, 477–492 (2021). https://doi.org/10.1007/s00384-020-03827-0

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  • DOI: https://doi.org/10.1007/s00384-020-03827-0

Keywords

  • Rectum
  • Cancer
  • Abdominoperineal excision
  • Perineal closure