A method for perineal hernia prevention after extralevator abdominoperineal excision. Analysis of an interim cohort

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Abstract

Background. Extralevator abdominoperineal excision (eAPR) improves oncological outcomes in low rectal cancer but creates a large pelvic floor defect and carries a high risk of perineal hernia – a significant late complication that markedly impairs quality of life. Mesh reinforcement for prevention of the hernia is under active investigation, yet evidence on transabdominal synthetic mesh placement remains scarce.

Aim. To evaluate feasibility, safety, and preliminary effectiveness of transabdominal synthetic mesh placement for perineal hernia prevention following eAPR in an interim patient cohort.

Materials and methods. A prospective comparative study with historical controls was performed. The study group (n = 13) consisted of patients who underwent laparoscopic eAPR with prophylactic transabdominal placement of anti-adhesive synthetic mesh between September 2023 and May 2024. The control group (n = 13) consisted of retrospectively matched patients after eAPR without pelvic floor reconstruction (2020–2023). Groups were comparable by key clinical characteristics. Follow-up was 12 months and included clinical examination and pelvic magnetic resonance imaging every 3 months. Interim descriptive analysis.

Results. Operative time significantly longer in the study group (296.9 ± 38.3 min versus 209.6 ± 37.7 min; p < 0.001). No differences in blood loss, Clavien–Dindo ≥III complications, or duration of hospital stay were observed. Perineal hernia developed in 1 / 13 (8 %) of study patients (after early mesh explantation due to complication) versus 10 / 13 (77 %) of controls (p = 0.001). Symptomatic hernias requiring reintervention were 0 in the study group and 40 % in the control group. Median time to hernia detection in the control group was 6 months (3–9).

Conclusion. Interim data indicate acceptable safety and good feasibility of transabdominal synthetic mesh placement. The technique is associated with substantially reduced rates of perineal hernia development, including clinically relevant cases. Definitive conclusions require recruitment of target sample size and longer-term follow-up.

About the authors

Aslan M. Ozdoev

A. S. Loginov Moscow Clinical Scientific Center, Moscow Healthcare Department

Author for correspondence.
Email: surgeon.ozdoy@gmail.com
ORCID iD: 0009-0006-7208-8218
Russian Federation, Build. 1, 1 Novogireevskaya St., Moscow, 111123

A. B. Baychorov

A. S. Loginov Moscow Clinical Scientific Center, Moscow Healthcare Department

Email: surgeon.ozdoy@gmail.com
ORCID iD: 0000-0003-0641-0572
Russian Federation, Build. 1, 1 Novogireevskaya St., Moscow, 111123

М. A. Danilov

A. S. Loginov Moscow Clinical Scientific Center, Moscow Healthcare Department

Email: surgeon.ozdoy@gmail.com
ORCID iD: 0000-0001-9439-9873
Russian Federation, Build. 1, 1 Novogireevskaya St., Moscow, 111123

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