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Pelvic floor reconstruction by modified rectus abdominis myoperitoneal (MRAM) flap after pelvic exenterations
D Cibula1, M Zikan1, D Fischerova1
1Gynecologic Oncology Center, Department of Obstetrics and Gynecology, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Czech Republic.
Objective:
To describe the technique and report experiences with pelvic floor reconstruction by modified rectus abdominis myoperitoneal (MRAM) flap after extensive pelvic procedures.
Methods:
Surgical technique of MRAM harvest and transposition is carefully described. The patients in whom pelvic floor reconstruction with MRAM after either infralevator pelvic exenteration and/or extended lateral pelvic sidewall excision was carried out were enrolled into the study (MRAM group, n=16). Surgical data, post-operative morbidity, and disease status were retrospectively assessed. The results were compared with a historical cohort of patients, in whom an exenterative procedure without pelvic floor reconstruction was performed at the same institution (control group, n=24).
Results:
Both groups were balanced in age, BMI, tumor types, and previous treatment. Substantially less patients from the MRAM group required reoperation within 60days of the surgery (25% vs. 50%) which was due to much lower rate of complications potentially related to empty pelvis syndrome (1 vs. 7 reoperations) (p=0.114). Late post-operative complication rate was substantially lower in the MRAM group (any grade: 79% vs. 44%; grade≥3: 37% vs. 6%) (p=0.041). The performance status 6months after the surgery was ≤1 in the majority of patients in MRAM (81%) while in only 38% of patients from the control group (p=0.027). There was one incisional hernia in MRAM group while three cases were reported in the controls.
Conclusions:
Pelvic floor reconstruction by MRAM in patients after pelvic exenterative procedures is associated with a substantial decrease in postoperative complications that are potentially related to empty pelvis syndrome.
Insights
Modified rectus abdominis myoperitoneal (MRAM) flap reconstruction significantly reduces complications after extensive pelvic surgery. This technique improves patient outcomes and lowers the risk of empty pelvis syndrome complications.
Area of Science:
- Surgical Oncology
- Reconstructive Surgery
- Pelvic Surgery
Background:
- Extensive pelvic procedures, such as pelvic exenteration, can lead to significant morbidity.
- Pelvic floor reconstruction is crucial for restoring function and reducing complications after such surgeries.
- The modified rectus abdominis myoperitoneal (MRAM) flap is a reconstructive option for the pelvic floor.
Purpose of the Study:
- To describe the surgical technique of MRAM flap for pelvic floor reconstruction.
- To report the clinical experiences and outcomes of MRAM flap reconstruction after extensive pelvic procedures.
- To compare the outcomes of MRAM flap reconstruction with a historical control group.
Main Methods:
- A retrospective study involving 16 patients who underwent MRAM flap reconstruction after pelvic exenteration or sidewall excision.
- Comparison with a historical cohort of 24 patients who had exenterative procedures without pelvic floor reconstruction.
- Assessment of surgical data, postoperative morbidity, complication rates, and patient performance status.
Main Results:
- The MRAM group showed a lower reoperation rate within 60 days (25% vs. 50%) and fewer complications related to empty pelvis syndrome.
- Late postoperative complication rates were substantially lower in the MRAM group (37% vs. 6% for grade ≥3 complications).
- Improved performance status was observed in the MRAM group at 6 months post-surgery (81% vs. 38%).
Conclusions:
- Pelvic floor reconstruction using the MRAM flap is associated with a significant reduction in postoperative complications.
- The MRAM flap effectively mitigates complications potentially related to empty pelvis syndrome.
- This technique enhances functional recovery and improves outcomes for patients undergoing extensive pelvic surgery.
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