AIM OF STUDY

To determine the optimal variant of the plastic surgery of pelvic floor defect in patients after extralevator abdominal-perineal extirpation (ElAPE) of the rectum.

MATERIALS AND METHODS

The study included 36 patients after ElAPE due to locally advanced lower ampullar colorectal cancer. Local tissue plastic repair was performed in 25 patients (group 1), gluteoplastic — in 11 (group 2). In a comparative analysis, the duration of perineal stage of the operation, the number of postoperative hospital bed-days and the frequency of inflammatory complications were evaluated.

RESULTS

With gluteoplastic, the average duration of the perineal stage was 81.4±38.1 minutes, with plastic by local tissues — 80.8±30.3 minutes. In the postoperative period, impaired healing of the perineal wound was noted in 20% of patients only in the group of plastic with local tissues. Necrosis of the displaced flap of the gluteus maximus muscle was recorded in 1 patient. The incidence of failure of the perineal wound sutures in both groups was almost the same and did not exceed 9.1%. The duration of the postoperative period in patients of the 2nd group was slightly lower and amounted to 16.5±6.8 days versus 18.1±8.9 days in patients of the 1st group.

CONCLUSION

Plastic surgery with a flap of gluteus maximus muscle is a simple, safe and reliable option for reconstruction of pelvic floor after ElAPE, due to the lower incidence of postoperative complications and the length of patient’s hospital stay.