Skip to main content

Table 1 Details of the surgical procedures with post-operative outcomes

From: Dorsal approach with tailored partial sacrectomy and gluteal V–Y fasciocutaneous advancement flap for the management of recurrent pelvic sepsis; case report

 

Patient 1

Patient 2

Patient 3

Age1

80

66

51

BMI

26.5

28.1

30.0

Gender

Male

Male

Male

Comorbidity

Hypertension, diabetes

Myocardial infarction

Occlusive peripheral arterial disease

Prostate cancer

Pulmonary embolism

Pelvic radiotherapy

5 × 5 Gy

5 × 5 Gy

Brachytherapy prostate

Chemoradiotherapy

Surgical History for underlying disease

LAR for ypT1N0M0 rectal cancer with temporary ileostomy

Endoscopic dilation of anastomotic stenosis

LAR for ypT3N0M0 rectal cancer with temporary ileostomy

Segmental small bowel resection for enterocutaneous fistula

APR for locally recurrent rectal cancer with omentoplasty

Double loop colostomy for obstruction, LAR for ypT2N0M0 rectal cancer, dismantling anastomosis with end-colostomy for leakage

First salvage surgery

Indication

Chronic presacral sinus, with purulent discharge, bleeding and anemia

Chronic pelvic abscess with involvement of prostate, perineal fistula to the bladder

Chronic presacral sinus with debilitating discharge

Time from index surgery

128 months

100 months after LAR

36 months after APR

20 months

Operative details

Intersphincteric resection anastomosis with omentoplasty and end colostomy

Cystoprostatectomy, urostomy using colon conduit, transverse end colostomy and revision omentoplasty

Intersphincteric resection rectal stump, omentoplasty, incisional hernia repair

Postoperative complications

Persistent presacral abscess, treated with surgical drainage/endosponge

Persistent pelvic abscess,

Ileus due to adhesions on omentoplasty, treated with

ileocecal resection

Persistent presacral abscess, drainage procedures

Partial sacrectomy and gluteal VY fasciocutaneous advancement flap

 Indication

Pelvic sepsis with fever, severe pain and purulent discharge

Pelvic abscess with debilitating purulent discharge

Recurrent presacral abscess after symptom free interval of 6 years, pain, fever

 Time from first salvage surgery

2 months

16 months

93 months

 Operative details

Sacrectomy S3 unilateral VY from left buttock

Sacrectomy S4 bilateral VY

Sacrectomy S4, revision omentoplasty unilateral VY from left buttock

 Duration of surgery (h)

4:14

4:07

3:23

 Hospital stay (days)

15

12

5

 Vacuum drain removal (days after surgery)

13

14

17

 Post-operative complications

Fluid collection, percutaneous drainage and prolonged antibiotics

Small perineal sinus, healed with conservative management

Persisting pain, slowly improving during 12 months

 Follow-up

3 months

48 months

21 months

 Pelviperineal status

Wound healed

No signs of recurrent abscess, diminishing pain

Healed perineum with good quality of life until death of recurrent cancer

Healed perineum, no signs of recurrent abscess, good quality of life

  1. 1Age at time of partial sacrectomy and gluteal VY fasciocutaneous advancement flap; BMI body mass index