Annals of Surgical Oncology

, Volume 19, Issue 2, pp 502–503 | Cite as

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

  • R. E. HorchEmail author
  • A. D’Hoore
  • T. Holm
  • U. Kneser
  • W. Hohenberger
  • A. Arkudas
Gastrointestinal Oncology



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.


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.


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.


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.


Bone Tissue Engineering Rectal Stump Human Bone Marrow Stromal Cell Complete Tumor Removal Vertical Rectus Abdominis Myocutaneous 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Supplementary material

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Copyright information

© Society of Surgical Oncology 2011

Authors and Affiliations

  • R. E. Horch
    • 1
    Email author
  • A. D’Hoore
    • 2
  • T. Holm
    • 3
  • U. Kneser
    • 1
  • W. Hohenberger
    • 4
  • A. Arkudas
    • 1
  1. 1.Department of Plastic and Hand SurgeryUniversity of Erlangen Medical CenterErlangenGermany
  2. 2.Department of Abdominal SurgeryUniversity Clinics GasthuisbergLeuvenBelgium
  3. 3.Section of Coloproctology, Department of SurgeryKarolinska University HospitalStockholmSweden
  4. 4.Department of General and Visceral SurgeryUniversity Hospital Erlangen, Friedrich-Alexander Universität Erlangen-NürnbergErlangenGermany

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