Dynamic magnetic resonance imaging evaluation of pelvic reconstruction with porcine dermal collagen mesh following extra-levator abdominoperineal excision for primary rectal cancer

Abstract

The implantation of a porcine dermal collagen mesh is an effective and reliable option for pelvic floor reconstruction after extra-levator abdominoperineal excision. Despite a high incidence of primary wound infections, the healing rate was satisfactory, no mesh had to be removed, and long-term stability could be achieved.

Closure of the perineal defect after abdominoperineal excision for rectal adenocarcinoma – ACPGBI Position Statement

“…Fifteen studies were identified through the literature search [11,12,[34][35][36][37][38][39][40][41][42][43][44][45][46], reporting on 451 patients who underwent mesh reconstruction of the perineum following ELAPE, including 81 patients from two RCTs that compared mesh with primary closure [11,12]. Results of these studies are summarised in Table 4.…”

Dynamic MRI to assess pelvic floor reconstruction with Strattice™ mesh after extralevator abdominoperineal excision for rectal cancer – a video vignette

“…Dynamic MRI was performed 12 months after the eLAPE procedure The cine MRI sequence was a T2weighted TrueFISP (True fast imaging with steady state precession) of a single, 10 mm slice, repeated at sub 0.5 s intervals to give a 'CINE' loop, and was acquired when the patient was asked to strain, thus demonstrating an active Valsalva manoeuvre [1]. T2-weighted sagittal and coronal views were obtained at rest in the supine position with the patient performing a Valsalva manoeuvre flowed by imaging at rest, when the patient was not performing a Valsalva manoeuvre [2,3].…”

“…Many techniques have been described to solve the difficulty of rectal division [1,2], but classical options such as rectal eversion should not be forgotten. Eversion of the anal canal and rectal stump after division of the colon at a higher level was employed to perform proctocolectomy with handsewn ileoanal pouch anastomosis [3,4]. This technique, often using a curved circular stapler, can be invaluable in performing a sphinctersaving operation in colorectal surgery [5].…”

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We are currently carrying out a multicentre clinical trial comparing lithotomy with the prone position for the perineal part of the abdominoperineal rectal excision (NCT02163785) [3]. To date half of the necessary sample has been recruited, and definitive results will be published in 2017.

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“…Dear Sir, Recently, the Firefly TM technique (Intuitive Surgical Inc., Sunnyvale, CA, USA), the intra-operative near infrared fluorescence imaging system, was incorporated into the Da Vinci Si robotic system and allowed surgeons to identify intravascular near infrared fluorescence signals in real time. The indications for use of this imaging include identification of the vascular system, assessment of tissue perfusion, visualization of hepatobiliary anatomy and sentinel lymph node mapping [1][2][3]. In our video we present the possible value of intra-operative fluorescence imaging in the identification of the collateral vessels around the inferior mesenteric vein (IMV) and pancreas and identification of the left colic artery from the inferior mesenteric artery (IMA) within the mesenteric tissue during robotic total mesorectal excision for rectal cancer using the Firefly TM technique.…”