Phantom rectal sensations following abdominoperineal excision of the rectum (APER) and vertical rectus abdominis myocutaneous (VRAM) flap perineal reconstruction

Abstract

Fifty percent of patients experience PR sensations post-surgery, comparable with reported data for patients who have undergone APER alone. The addition of VRAM reconstruction does not significantly alter the prevalence of PR symptoms. This paper provides further evidence that phantom rectum occurs frequently and thus all patients undergoing excision of the rectum should be counselled appropriately.

Flap Reconstruction of Perineal Defects after Pelvic Exenteration: A Systematic Description of Four Choices of Surgical Reconstruction Methods

“…Reasons for upgrading and downgrading (mostly for study limitations) are listed in Table 3. 1–91 One article was graded as high quality, seven articles were graded as low quality, and 50 articles were graded as very low quality. Three articles on vertical rectus abdominis musculocutaneous flap reconstruction showed a small relative risk on pelvic abscess compared to primary closure and were upgraded for a large magnitude of effect.…”

“…40 Quality of life was negatively affected in 15 of 34 patients (44 percent), with sleep disturbance, feelings of stress/sadness, anxiety, and limitations of daily activities as the most frequently mentioned reasons. 31…”

“…Thirty-nine articles described 1460 patients with abdominal flap reconstruction, with the majority reporting on the vertical rectus abdominis musculocutaneous flap. 17–47 Fourteen articles described fasciocutaneous 18,47–53 or myocutaneous 54–59 gluteal flap reconstructions in 335 patients. Four studies reported on muscle or musculocutaneous gracilis flaps 28,60–62 and one study reported on vastus lateralis flaps with or without an anterolateral thigh 63 flap in a total of 95 patients.…”

“…33 sadness, anxiety, and limitations of daily activities as the most frequently mentioned reasons. 31 In addition, Corte et al compared sexual function in women who underwent abdominoperineal resection after primary closure and vertical rectus abdominis musculocutaneous flap closure and found no differences in mean scores (primary, 21 of 36; vertical rectus abdominis musculocutaneous, 12.9 of 36). 26 In the only study reporting on quality of life after gluteal flap reconstruction, Haapamäki et al found a mean index of 0.71 for the EuroQol group (EQ-5D instrument), comparable to healthy population reference values.…”

“…Quality of life after rectus abdominis musculocutaneous flap was reported by three studies. 31,33,40 Holman et al found that most women and all men who underwent reconstruction scored comparable or higher scores on emotional, role functioning, and body image compared to mean control group scores. Also, women reported less pain and fatigue.…”