Uterus and extralevator abdominoperineal excision: a technique

Area of Science:

• Surgical Oncology
• Pelvic Reconstruction
• Gastrointestinal Surgery

Background:

• Perineal hernia is a known complication following abdominoperineal excision of the rectum.
• Extralevator abdominoperineal excision has an increasing incidence of perineal hernia.
• Current prevention strategies include mesh, muscle flaps, or layered closure, with no standardized approach.

Purpose of the Study:

• To describe a novel technique for preventing perineal herniation using the uterus as natural packing material in postmenopausal women.
• To prevent small bowel prolapse into the pelvis and subsequent perineal hernia formation.

Main Methods:

• The technique involves retroverting the uterus in situ.
• The uterus is secured to the bony pelvis using nonabsorbable sutures.
• Abdominal and perineal approaches can be utilized for fixation.

Main Results:

• Uterine interposition is a practical, low-risk, and inexpensive solution for selected patients.
• This method avoids the costs and potential complications associated with prosthetic mesh or myoplastic reconstructions.

Conclusions:

• This procedure is suitable for women with a uterus in situ, particularly postmenopausal patients.
• Potential side effects include dyspareunia; caution is advised in premenopausal women due to menstrual issues.
• Care must be taken to avoid injury to pelvic nerves and vasculature.