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Pieter J Tanis - One of the best experts on this subject based on the ideXlab platform.

  • further insights into the treatment of Perineal Hernia based on a the experience of a single tertiary centre
    Colorectal Disease, 2020
    Co-Authors: R D Blok, Gijsbert D Musters, W A Bemelman, T P A Brouwer, Sarah Sharabiany, R Hompes, Pieter J Tanis
    Abstract:

    Aim: There is little evidence concerning the optimal surgical technique for the repair of Perineal Hernia. This study aimed to report on the evolution of a technique for repair of Perineal Hernia by analysing the experience in a tertiary referral centre. Method: This was a retrospective review of consecutive patients who underwent Perineal Hernia repair after abdominoPerineal excision in a tertiary referral centre. The main study end-points were rate of recurrent Perineal Hernia, Perineal wound complications and related re-intervention. Results: Thirty-four patients were included: in 18 patients a biological mesh was used followed by 16 patients who underwent synthetic mesh repair. Postoperative Perineal wound infection occurred in two patients (11%) after biological mesh repair compared with four (25%) after synthetic mesh repair (P = 0.387). None of the meshes were explanted. Recurrent Perineal Hernia following biological mesh was found in 7 of 18 patients (39%) after a median of 33 months. The recurrence rate with a synthetic mesh was 5 of 16 patients (31%) after a median of 17 months (P = 0.642). Re-repair was performed in four (22%) and two patients (13%), respectively (P = 0.660). Eight patients required a transposition flap reconstruction to close the perineum over the mesh, and no recurrent Hernias were observed in this subgroup (P = 0.030). No mesh-related small bowel complications occurred. Conclusion: Recurrence rates after Perineal Hernia repair following abdominoPerineal excision were high, and did not seem to be related to the type of mesh. If a transposition flap was added to the mesh repair no recurrences were observed, but this finding needs confirmation in larger studies.

  • response to jensen et al 2014 pelvic floor reconstruction with a biological mesh after extralevator abdominoPerineal excision leads tolow wound complications and Perineal Hernia rates with minor movement limitations
    Colorectal Disease, 2014
    Co-Authors: Gijsbert D Musters, W A Bemelman, Pieter J Tanis
    Abstract:

    Jensen et al describe their experience with reconstruction of the pelvic floor using a biological mesh after extralevator abdominoPerineal excision (ELAPE)[1]. The title states that a biological mesh leads to low Perineal wound complications and Perineal Hernia rates. Surprisingly the authors conclude at the end of the discussion that "the biological mesh reconstruction of the pelvic floor results in transient pain with a high rate of wound complications". But this is considered to be acceptable given the advantages, in the light of a low Perineal Hernia rate and no major limitations of movement or sitting according to the authors. This article is protected by copyright. All rights reserved

  • Perineal Hernia repair after abdominoPerineal resection a pooled analysis
    Colorectal Disease, 2012
    Co-Authors: M Mjoli, D A M Sloothaak, Christianne J Buskens, W A Bemelman, Pieter J Tanis
    Abstract:

    Aim  The purpose of this study was to determine treatment characteristics and clinical outcome for patients with Perineal Hernia after abdominoPerineal excision (APE). Method  A systematic search of the literature revealed 40 individually documented patients, published between 1944 and 2010. Three additional patients treated at our centre were added. Patient characteristics, type of repair and outcome were entered into a database and a pooled analysis of these 43 patients was performed. Results  The pooled analysis revealed a median time interval of 8 months between APE and surgical repair of Perineal Hernia. The surgical approaches were Perineal in 22 patients, open abdominal in 11, open abdominoPerineal in three, laparoscopic in five and laparoscopic-Perineal in two patients. A primary recurrence was documented in 13 patients and a second recurrence in three. The recurrence rate was 5/25 for synthetic or biological mesh, 6/12 for primary closure and 2/6 for the remaining techniques. Recurrent Perineal Hernia was repaired using a synthetic or biological mesh (n = 6), primary closure (n = 5) or a muscle flap (gluteus or gracilis; n = 4). Conclusion  From these limited and biased data based on published case descriptions, it appears that the recurrence rate of primary Perineal Hernia repair after APE is lower with the use of a mesh or other assisted closure than with primary suture repair.

S. K. Bhat - One of the best experts on this subject based on the ideXlab platform.

Gijsbert D Musters - One of the best experts on this subject based on the ideXlab platform.

  • further insights into the treatment of Perineal Hernia based on a the experience of a single tertiary centre
    Colorectal Disease, 2020
    Co-Authors: R D Blok, Gijsbert D Musters, W A Bemelman, T P A Brouwer, Sarah Sharabiany, R Hompes, Pieter J Tanis
    Abstract:

    Aim: There is little evidence concerning the optimal surgical technique for the repair of Perineal Hernia. This study aimed to report on the evolution of a technique for repair of Perineal Hernia by analysing the experience in a tertiary referral centre. Method: This was a retrospective review of consecutive patients who underwent Perineal Hernia repair after abdominoPerineal excision in a tertiary referral centre. The main study end-points were rate of recurrent Perineal Hernia, Perineal wound complications and related re-intervention. Results: Thirty-four patients were included: in 18 patients a biological mesh was used followed by 16 patients who underwent synthetic mesh repair. Postoperative Perineal wound infection occurred in two patients (11%) after biological mesh repair compared with four (25%) after synthetic mesh repair (P = 0.387). None of the meshes were explanted. Recurrent Perineal Hernia following biological mesh was found in 7 of 18 patients (39%) after a median of 33 months. The recurrence rate with a synthetic mesh was 5 of 16 patients (31%) after a median of 17 months (P = 0.642). Re-repair was performed in four (22%) and two patients (13%), respectively (P = 0.660). Eight patients required a transposition flap reconstruction to close the perineum over the mesh, and no recurrent Hernias were observed in this subgroup (P = 0.030). No mesh-related small bowel complications occurred. Conclusion: Recurrence rates after Perineal Hernia repair following abdominoPerineal excision were high, and did not seem to be related to the type of mesh. If a transposition flap was added to the mesh repair no recurrences were observed, but this finding needs confirmation in larger studies.

  • randomized controlled multicentre study comparing biological mesh closure of the pelvic floor with primary Perineal wound closure after extralevator abdominoPerineal resection for rectal cancer biopex study
    BMC Surgery, 2014
    Co-Authors: Gijsbert D Musters, Willem A Bemelman, Robbert J I Bosker, Jacobus W A Burger, Peter Van Duijvendijk, Boudewijn Van Etten, Anna A W Van Geloven, Eelco J R De Graaf, C Hoff, Niels De Korte
    Abstract:

    Primary Perineal wound closure after conventional abdominoPerineal resection (cAPR) for rectal cancer has been the standard of care for many years. Since the introduction of neo-adjuvant radiotherapy and the extralevator APR (eAPR), oncological outcome has been improved, but at the cost of increased rates of Perineal wound healing problems and Perineal Hernia. This has progressively increased the use of biological meshes, although not supported by sufficient evidence. The aim of this study is to determine the effectiveness of pelvic floor reconstruction using a biological mesh after standardized eAPR with neo-adjuvant (chemo)radiotherapy compared to primary Perineal wound closure. In this multicentre randomized controlled trial, patients with a clinical diagnosis of primary rectal cancer who are scheduled for eAPR after neo-adjuvant (chemo)radiotherapy will be considered eligible. Exclusion criteria are prior radiotherapy, sacral resection above S4/S5, allergy to pig products or polysorbate, collagen disorders, and severe systemic diseases affecting wound healing, except for diabetes. After informed consent, 104 patients will be randomized between standard care using primary wound closure of the perineum and the experimental arm consisting of suturing a biological mesh derived from porcine dermis in the pelvic floor defect, followed by Perineal closure similar to the control arm. Patients will be followed for one year after the intervention and outcome assessors and patients will be blinded for the study treatment. The primary endpoint is the percentage of uncomplicated Perineal wound healing, defined as a Southampton wound score of less than II on day 30. Secondary endpoints are hospital stay, incidence of Perineal Hernia, quality of life, and costs. The BIOPEX-study is the first randomized controlled multicentre study to determine the additive value of using a biological mesh for Perineal wound closure after eAPR with neo-adjuvant radiotherapy compared to primary Perineal wound closure with regard to Perineal wound healing and the occurrence of Perineal Hernia. NCT01927497 (Clinicaltrial.gov).

  • response to jensen et al 2014 pelvic floor reconstruction with a biological mesh after extralevator abdominoPerineal excision leads tolow wound complications and Perineal Hernia rates with minor movement limitations
    Colorectal Disease, 2014
    Co-Authors: Gijsbert D Musters, W A Bemelman, Pieter J Tanis
    Abstract:

    Jensen et al describe their experience with reconstruction of the pelvic floor using a biological mesh after extralevator abdominoPerineal excision (ELAPE)[1]. The title states that a biological mesh leads to low Perineal wound complications and Perineal Hernia rates. Surprisingly the authors conclude at the end of the discussion that "the biological mesh reconstruction of the pelvic floor results in transient pain with a high rate of wound complications". But this is considered to be acceptable given the advantages, in the light of a low Perineal Hernia rate and no major limitations of movement or sitting according to the authors. This article is protected by copyright. All rights reserved

Katta M Girisha - One of the best experts on this subject based on the ideXlab platform.

W A Bemelman - One of the best experts on this subject based on the ideXlab platform.

  • further insights into the treatment of Perineal Hernia based on a the experience of a single tertiary centre
    Colorectal Disease, 2020
    Co-Authors: R D Blok, Gijsbert D Musters, W A Bemelman, T P A Brouwer, Sarah Sharabiany, R Hompes, Pieter J Tanis
    Abstract:

    Aim: There is little evidence concerning the optimal surgical technique for the repair of Perineal Hernia. This study aimed to report on the evolution of a technique for repair of Perineal Hernia by analysing the experience in a tertiary referral centre. Method: This was a retrospective review of consecutive patients who underwent Perineal Hernia repair after abdominoPerineal excision in a tertiary referral centre. The main study end-points were rate of recurrent Perineal Hernia, Perineal wound complications and related re-intervention. Results: Thirty-four patients were included: in 18 patients a biological mesh was used followed by 16 patients who underwent synthetic mesh repair. Postoperative Perineal wound infection occurred in two patients (11%) after biological mesh repair compared with four (25%) after synthetic mesh repair (P = 0.387). None of the meshes were explanted. Recurrent Perineal Hernia following biological mesh was found in 7 of 18 patients (39%) after a median of 33 months. The recurrence rate with a synthetic mesh was 5 of 16 patients (31%) after a median of 17 months (P = 0.642). Re-repair was performed in four (22%) and two patients (13%), respectively (P = 0.660). Eight patients required a transposition flap reconstruction to close the perineum over the mesh, and no recurrent Hernias were observed in this subgroup (P = 0.030). No mesh-related small bowel complications occurred. Conclusion: Recurrence rates after Perineal Hernia repair following abdominoPerineal excision were high, and did not seem to be related to the type of mesh. If a transposition flap was added to the mesh repair no recurrences were observed, but this finding needs confirmation in larger studies.

  • response to jensen et al 2014 pelvic floor reconstruction with a biological mesh after extralevator abdominoPerineal excision leads tolow wound complications and Perineal Hernia rates with minor movement limitations
    Colorectal Disease, 2014
    Co-Authors: Gijsbert D Musters, W A Bemelman, Pieter J Tanis
    Abstract:

    Jensen et al describe their experience with reconstruction of the pelvic floor using a biological mesh after extralevator abdominoPerineal excision (ELAPE)[1]. The title states that a biological mesh leads to low Perineal wound complications and Perineal Hernia rates. Surprisingly the authors conclude at the end of the discussion that "the biological mesh reconstruction of the pelvic floor results in transient pain with a high rate of wound complications". But this is considered to be acceptable given the advantages, in the light of a low Perineal Hernia rate and no major limitations of movement or sitting according to the authors. This article is protected by copyright. All rights reserved

  • Perineal Hernia repair after abdominoPerineal resection a pooled analysis
    Colorectal Disease, 2012
    Co-Authors: M Mjoli, D A M Sloothaak, Christianne J Buskens, W A Bemelman, Pieter J Tanis
    Abstract:

    Aim  The purpose of this study was to determine treatment characteristics and clinical outcome for patients with Perineal Hernia after abdominoPerineal excision (APE). Method  A systematic search of the literature revealed 40 individually documented patients, published between 1944 and 2010. Three additional patients treated at our centre were added. Patient characteristics, type of repair and outcome were entered into a database and a pooled analysis of these 43 patients was performed. Results  The pooled analysis revealed a median time interval of 8 months between APE and surgical repair of Perineal Hernia. The surgical approaches were Perineal in 22 patients, open abdominal in 11, open abdominoPerineal in three, laparoscopic in five and laparoscopic-Perineal in two patients. A primary recurrence was documented in 13 patients and a second recurrence in three. The recurrence rate was 5/25 for synthetic or biological mesh, 6/12 for primary closure and 2/6 for the remaining techniques. Recurrent Perineal Hernia was repaired using a synthetic or biological mesh (n = 6), primary closure (n = 5) or a muscle flap (gluteus or gracilis; n = 4). Conclusion  From these limited and biased data based on published case descriptions, it appears that the recurrence rate of primary Perineal Hernia repair after APE is lower with the use of a mesh or other assisted closure than with primary suture repair.