SP 1.13 Perineal Reconstruction After Abdominoperineal Resection: A Scoping Review of Biological Mesh Versus Primary Closure

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Abstract Aims Perineal wound complications and perineal hernia are major causes of morbidity post abdominoperineal resection (APR), particularly following extralevator APR and neoadjuvant radiotherapy. Biological meshes are increasingly utilized for pelvic floor reconstruction, nonetheless, comparative outcomes with primary closure are inconsistently reported. This scoping review aimed to map evidence on perineal reconstruction strategies following APR. Methods A PRISMA-ScR–informed scoping review included randomised trials, registries, cohort studies and case series reporting outcomes after APR or extralevator APR using biological mesh, primary closure, or both. Data were organised on reconstructive technique, radiotherapy use, early perineal morbidity, perineal hernia, reoperation, follow-up duration, and functional or radiologic assessment. Results Eleven studies were included. Early perineal wound infections and delayed healing were common across procedures, with reported early wound complication rates typically ranging from 30–55% and no consistent improvement with mesh compared with primary closure. Randomised evidence showed similar early wound healing at 30 days, while longer-term follow-up reported a lower incidence of symptomatic perineal hernia following biological mesh reconstruction (approximately 7% versus 30% at 5 years). Observational studies indicated a high eventual perineal wound healing by 12 months (>80–90%), low mesh explantation rates, and durable pelvic floor integrity. Conclusions Biological mesh reconstruction post APR does not reliably enhance early perineal wound outcomes compared to primary closure but may correlate with lower long-term perineal hernia. Heterogeneity in techniques and outcome reporting underscores the need for standardized, prospective comparative studies.

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