Primary vaginal and pelvic floor reconstruction at the time of pelvic exenteration: A study of morbidity

Purpose. The purpose of this study was to analyze our experience with the i nfluence of reconstructive techniques at the time of pelvic exenteration on morbidity. Materials and Methods. Between June 1986 and December 1998, 60 pelvic exent erations for gynecologic malignancies were performed in our hospital. Forty -five were selected for this study because they met two criteria: they were performed by the same team (gynecologic oncologist), and they had similar primary tumors. There were 38 cervical, 2 vaginal, and 5 uterine malignanci es. Sixteen patients underwent reconstructive surgery: 11 (68.8%) with plac ement of a myocutaneous flap with left rectus abdominis, 3 (18.8%) with gra cilis muscle, and 2 (12.5%) with the Singapore fasciocutaneous flap. Twenty -nine patients had no reconstruction. Records were reviewed and statistical analysis was performed. Results. Attachment of the grafts was complete in 14 of 16 (87.5%), with a partial vulvovaginal dehiscence in 2 cases. Morbidities included secondary infection in 3 (18.8%), partial necrosis in 3 (18.8%), and partial stenosis in 5 (31.6%); the last was significantly associated with a gracilis flap ( P = 0.015). There were no statistical differences between neovagina and non neovagina groups with respect to the rate of fever, small bowel fistula, bo wel obstruction, wound infection or dehiscence, hernia, colorectal leak, co lostomy or urostomy prolapse, deep vein thrombosis, pulmonary embolism, int raoperative blood transfusions, or hospital stay. There were no pelvic absc esses in the neovagina group compared with 27% (6/29) in the other group (P = 0.050). Surgery was significantly longer (P = 0.019) for the reconstruct ive surgery group, with no statistical difference between different kinds o f flaps. There were no deaths in either group. Conclusions. Reconstruction of the vagina and pelvic floor at the time of p elvic exenteration can be done safely. Although this increases surgical tim e, morbidity is not significantly increased. The rectus abdominis flap seem s to be the preferable option for primary vaginal and pelvic floor reconstr uction. (C) 2000 Academic Press.