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 |