Search Our Scientific Publications & Authors

Int J Colorectal Dis 2022 Jun 25. Epub 2022 Jun 25.

Department of General and Visceral Surgery, Dresden-Friedrichstadt General Hospital, Teaching Hospital of the Technical University of Dresden, Friedrichstr. 41, Dresden, D-01067, Germany.

Purpose: No standard exists for reconstruction after extralevator abdominoperineal excision (ELAPE) and pelvic exenteration. We propose a tailored concept with the use of bilateral gluteal V-Y advancement flaps in non-extended ELAPE and with vertical myocutaneous rectus abdominis muscle (VRAM) flaps in extended procedures. This retrospective study analyzes the feasibility of this concept. Read More

Children (Basel) 2022 Jun 14;9(6). Epub 2022 Jun 14.

Division of Colorectal and Pelvic Reconstruction, Children's National Hospital, Washington, DC 20010, USA.

Cloaca is a rare, complex malformation encompassing the genitourinary and anorectal tract of the female in which these tracts fail to separate in utero, resulting in a single perineal orifice. Prenatal sonography detects a few cases with findings such as renal and urinary tract malformations, intraluminal calcifications, dilated bowel, ambiguous genitalia, a cystic pelvic mass, or identification of other associated anomalies prompting further imaging. Multi-disciplinary collaboration between neonatology, pediatric surgery, urology, and gynecology is paramount to achieving safe outcomes. Read More

Surg Case Rep 2022 Jun 20;8(1):116. Epub 2022 Jun 20.

Department of Gastroenterological Surgery, Fukuoka University Hospital, 7-45-1 Nanakuma, Jonan-ku, Fukuoka, 814-0180, Japan.

Introduction: Surgery for anal fistula cancer (AFC) associated with Crohn's disease usually entails extensive perineal wounds and dead space in the pelvis, which is often filled with a myocutaneous flap. However, use of a myocutaneous flap is invasive. We report a case of total pelvic exenteration (TPE) for AFC in which a myocutaneous flap was avoided by using an omental flap and negative pressure wound therapy (NPWT). Read More

J Plast Reconstr Aesthet Surg 2022 Apr 28. Epub 2022 Apr 28.

Department of Plastic and Reconstructive Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.

Background: Vulvovaginal reconstruction is challenging. In this study, we evaluated the outcomes of vulvovaginal reconstruction with "perineal perforator switch flap" (PPSF) and compared it with other conventional flaps. In addition, the long-term esthetic results were compared with the perineal perforator propeller flap (PPPF), which we previously used. Read More

Colorectal Dis 2022 Jun 16. Epub 2022 Jun 16.

Department of Surgery, Amsterdam UMC, University of Amsterdam, Cancer Centre Amsterdam, Amsterdam, the Netherlands.

Aim: The aim of this systematic review was to analyse recurrence rates after different surgical techniques for perineal hernia repair.

Method: All original studies (n ≥2) reporting recurrence rates after perineal hernia repair after abdominoperineal resection (APR) were included. The electronic database PubMed was last searched in December 2021. Read More

Dis Colon Rectum 2022 May 25. Epub 2022 May 25.

Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China.

Background: After abdominoperineal resection, low anterior resection, and end-colostomy for lower rectal cancer, it is necessary to reconstruct the pelvic peritoneum to avoid small bowel obstruction, perineal hernia, and radiation enteritis in patients for whom postoperative radiotherapy is planned. However, pelvic peritoneal closure is technically difficult in patients who lack enough peritoneum to cover the defect or have received neoadjuvant radiation and have a rigid pelvis.

Impact Of Innovation: The impact of this innovation is to reconstruct the pelvic peritoneum with the distal ileal mesentery laparoscopically. Read More

Prz Gastroenterol 2022 4;17(2):89-95. Epub 2021 Oct 4.

Department of Surgery, General University Hospital of Patras, Patras, Greece.

The perineal colostomy is a reconstruction method performed after abdominoperineal resection for rectal malignancy. In this technique, the permanent colostomy is not placed in the left quadrant of the abdomen, but in the perineum. According to the literature, this technique provides many advantages such as a higher degree of satisfaction and greater quality of life to patients. Read More

Colorectal Dis 2022 Jun 2. Epub 2022 Jun 2.

Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.

Aim: As the "empty pelvis syndrome" continues to pose challenges in patients undergoing radical pelvic exenteration, there remains an ongoing need to consider solutions to mitigate or avoid its associated morbidity. As such, this study aims to review the long-term outcomes of a proposed strategy of pelvic reconstruction with BioA mesh.

Method: We conducted a retrospective observational cohort study, reviewing cases of pelvic exenteration and/or pelvic bone resection involving BioA mesh pelvic reconstruction between 2017 and 2021 at our quaternary institution, identified from a prospectively collected database. Read More

Oper Orthop Traumatol 2022 May 29. Epub 2022 May 29.

Klinik für Unfall‑, Hand‑, Plastische- und Wiederherstellungschirurgie, Universitätsklinikum Würzburg, Oberdürrbacher Str. 6, 97080, Würzburg, Deutschland.

Objective: Soft tissue reconstruction of complex defects of the lower abdomen, groin, the perineum and the hip region present a reconstructive challenge. Besides free tissue transfer, pedicled flaps may also be utilized. Harvest of the vertical rectus abdominis flap causes a functional deficit by weakening the abdominal wall. Read More

Int J Environ Res Public Health 2022 05 21;19(10). Epub 2022 May 21.

Obstetrics and Gynecology, Materno-Infantil Hospital Regional Universitario Malaga, Avd Arroyo de los Angeles S/N, 29011 Malaga, Spain.

Fournier's gangrene (FG) is a serious pathology of the soft tissues and fascia of the perineum and genital region with a high morbidity and mortality rate. In recent years, the SGLT-2 inhibitor oral antidiabetic has been related to this entity. According to the new warnings from the main drug agencies, a compilation of cases has been initiated to establish or deny a possible causal relationship. Read More

ANZ J Surg 2022 May 23. Epub 2022 May 23.

Department of Colorectal Surgery, Western Health, Melbourne, Australia.

Background: Perineal wound morbidity following abdominoperineal resection (APR) is a significant challenge. Myocutaneous flap-based techniques have been developed to overcome morbidity associated with perineal reconstruction. We reviewed outcomes for patients undergoing APR in a hospital that performs inferior gluteal artery myocutaneous (IGAM) island transposition flaps and primary closure (PC) for perineal reconstruction. Read More

Urology 2022 May 15. Epub 2022 May 15.

University of Iowa, Carver College of Medicine, Department of Urology. Electronic address:

Objective: To evaluate the efficacy of early necrotizing soft-tissue infections of the genitalia (NSTIG) component separation, primary wound closure (CSC). We hypothesized that early CSC would be safe, decrease the need for split-thickness skin grafting (STSG) and decrease wound convalescence time.

Materials/methods: Management of consecutive NSTIG patients from a single institution were evaluated. Read More

Eur J Obstet Gynecol Reprod Biol 2022 Jul 11;274:56-61. Epub 2022 May 11.

Academic Department of Gynaecological Oncology, Royal Surrey NHS Foundation Trust, Surrey, UK. Electronic address:

For those with certain recurrent gynaecological cancers where primary management such as chemo-radiotherapy has failed, or in cases of recurrence following primary surgery, pelvic exenteration (PE) is considered the only curative option. Whilst initially considered a morbid procedure, improved surgical techniques, advancing technology, and nuanced reconstructive options have facilitated more radical resections and improved morbidity and mortality. Open PE remains the gold standard approach, however, minimally invasive techniques for PE may lessen morbidity whilst achieving the same oncological outcomes. Read More

Plast Reconstr Surg 2022 07 19;150(1):190-195. Epub 2022 May 19.

From the Department of Plastic and Reconstructive Surgery and Division of Colorectal Surgery, Department of Surgery, University of Nevada, Las Vegas School of Medicine.

Summary: The rectus abdominis flap has long been a workhorse in perineal reconstruction. Although traditionally approached though an external incision, the morbid nature of the incision and subsequent violation of the anterior rectus sheath has encouraged innovation of minimally invasive approaches for harvest. In this study, we present our experience, evolution, and comparative outcomes of robotic rectus abdominis muscle harvest. Read More

J Clin Med 2022 Apr 22;11(9). Epub 2022 Apr 22.

Department of Urology, University Hospital Frankfurt, Goethe University Frankfurt am Main, 60590 Frankfurt am Main, Germany.

Assessment of anterior urethral stricture (US) management of European urology experts is relevant to evaluate the quality of care given to the patients and plan future educational interventions. We assessed the practice patterns of the management of adult male anterior US among reconstructive urology experts from European countries. A 23-question online survey was conducted among European Association of Urology Section of Genito-Urinary Reconstructive Surgeons (ESGURS) members. Read More

Urology 2022 May 10. Epub 2022 May 10.

Belgrade Center for Urogenital Reconstructive Surgery, Belgrade, Serbia; School of Medicine, University of Belgrade, Belgrade, Serbia; Icahn School of Medicine at Mount Sinai, New York, NY. Electronic address:

Background: Penile inversion vaginoplasty still remains the gold standard in genital gender affirming surgeries in transwomen. However, insufficiency of the penile skin due to either radical circumcision or puberty blockers presents great challenge in vaginal reconstruction. Peritoneal pull-through vaginoplasty is well known technique for the treatment of vaginal absence in cis-woman due to vaginal agenesis or trauma. Read More

Urologiia 2022 May(2):113-121

GBU of the Republic of Dagestan City Clinical Hospital, Makhachkala, Russia.

The analysis of the results of perineal urethrostomy for urethral stricture in men for the period from 2000 to 2020 is presented in the article. We identified 29 original articles devoted to this technique, including 4 Russian and 25 foreign publications. In two studies, there were more than 100 patients, four studies included from 51 to 77 men, and in remaining studies less than 50 patients were analyzed. Read More

Clin Case Rep 2022 Apr 18;10(4):e05747. Epub 2022 Apr 18.

Surgery Department Kamenge Teaching Hospital University of Burundi Bujumbura Burundi.

Fournier's gangrene, a rapidly progressive necrotizing fasciitis of the perineum and external genitalia that leads to extensive soft tissue necrosis, remains a medical-surgical emergency. The authors present a case of coverage of a scrotal loss of substance with testicular exposure by a medial fasciocutaneous flap of the unilateral thigh after debridement and initial medical treatment of Fournier's gangrene in a 50-year-old quadriplegic patient. The clinical examination at 8 months showed an aesthetic and functional result. Read More

Asian J Androl 2022 Apr 15. Epub 2022 Apr 15.

Department of Urology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai Eastern Institute of Urologic Reconstruction, Shanghai Jiao Tong University, Shanghai 200233, China.

This study aimed to investigate the curative effect of spiral embedded flap urethroplasty for the treatment of meatal stenosis after penile carcinoma surgery. From January 2015 to January 2021, we used our technique to treat strictures of the external urethral orifice in seven patients, including four cases of meatal stenosis after partial penile resection and three cases of meatal stenosis after perineal stoma. All patients had previously undergone repeat urethral dilatation. Read More

Colorectal Dis 2022 Apr 15. Epub 2022 Apr 15.

Complex Cancer Clinic, St Mark's Hospital and Academic Institute, Harrow, UK.

Int J Surg Case Rep 2022 May 2;94:107013. Epub 2022 Apr 2.

Department of Urology, Cipto Mangunkusumo General Hospital, Faculty of Medicine, Universitas Indonesia, Indonesia. Electronic address:

Background: Epispadias is a rare condition. Epispadias in females is two times less common than in males. Female epispadias range from 1 in 160,000 to 480,000 live births. Read More

Int J Colorectal Dis 2022 May 8;37(5):1029-1034. Epub 2022 Apr 8.

Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden.

Purpose: Delayed perineal wound healing is a common complication after abdominoperineal resection (APR) in rectal cancer. The primary aim of this study was to evaluate the number of patients with delayed wound healing after APR. Secondary aims were to identify risk factors, and describe treatment. Read More

J Plast Reconstr Aesthet Surg 2022 Mar 8. Epub 2022 Mar 8.

Section of Plastic and Reconstructive Surgery, Department of General Surgery, Kepler University Hospital, Krankenhausstrasse 9, 4020 Linz, Austria; Johannes Kepler University Linz, Medical Faculty, Altenbergerstr. 69, 4040 Linz, Austria. Electronic address:

Background: The wide range of reconstructive purposes requires specific demands and considerations for appropriate flap selection. One versatile and reliable option, which is rarely reported in current literature, is the fasciocutaneous infragluteal (FCI) flap. In this study, we present our results of performing the FCI flap for different clinical indications. Read More

Colorectal Dis 2022 Apr 4. Epub 2022 Apr 4.

Division of Cancer Surgery, PeterMacCallum Cancer Centre, Victorian Comprehensive Cancer Centre, Melbourne, Victoria, Australia.

Aim: To explore the feasibility and safety of robotic beyond total mesorectal excision (TME) surgery for primary and recurrent pelvic malignancy.

Methods: Patients undergoing robotic beyond TME resections for primary or recurrent pelvic malignancy between July 2015 and July 2021 in a public quaternary and a private tertiary centre were included. Demographic and clinical data were recorded and outcomes analysed. Read More

Medicine (Baltimore) 2022 Feb;101(7):e28878

2th Department, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.

Rationale: Aphallia is an extremely rare congenital malformation of unknown cause, with few reports in the literature. It is usually associated with other urogenital and gastrointestinal anomalies and is believed to be a result of either the absence of a genital tubercle or chromosome polymorphism. Herein, we describe an extremely rare case of congenital aphallia with congenital urethrorectal fistula and describe our treatment for this patient. Read More

J Plast Reconstr Aesthet Surg 2022 Feb 24. Epub 2022 Feb 24.

Department of Plastic and Aesthetic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No.41 Damucang Hutong, Xicheng District, Beijing, China.

Background: Muscle-sparing vertical rectus abdominis myocutaneous (MS-VRAM) flaps are widely used in pelvic reconstruction. Aiming at optimal reconstructive outcomes, flap design and modification should be individualized to restore various kinds of defects.

Objective: Summarize an empirical strategy about MS-VRAM selection for different pelvic and perineal reconstructions. Read More

Gan To Kagaku Ryoho 2022 Mar;49(3):339-341

Dept. of Surgery, Osaka National Hospital.

An 85-year-old woman who visited the hospital with sores on the perianal skin was diagnosed with squamous cell carcinoma of the anal canal(cT3N1aM0, cStage ⅢC). She received chemoradiotherapy(radiation total 54 Gy/30 Fr, mitomycin C/capecitabine). The tumor initially shrank, but regrowth of the primary lesion, extensive perianal skin infiltration, and the appearance of para aortic lymph node metastases was observed 6 months later. Read More

Clin J Gastroenterol 2022 Jun 8;15(3):582-585. Epub 2022 Mar 8.

Department of Gastroenterological Surgery, Aichi Cancer Center Hospital, 1-1 Kanokoden, Chikusa, Nagoya, Aichi, 464-8681, Japan.

A 64-year-old male had undergone open pelvic exenteration and urinary tract reconstruction with an ileal conduit for locally advanced rectal cancer. Six years later, he developed a late-onset perineal intestinal fistula and was scheduled for surgical treatment. Before reoperation, a transnasal ileus tube was inserted toward the ileal fistula, and ureteric stents were placed by endoscopy into the bilateral ureters via an ileal conduit. Read More

Int Urol Nephrol 2022 May 5;54(5):1047-1052. Epub 2022 Mar 5.

SUNY Upstate Medical University, 750 East Adams Street, Syracuse, NY, 13210, USA.

Purpose: Patients with devastated bulbar urethras have limited surgical options to restore normal upright voiding. We investigated the long-term feasibility of using two independently vascularized urethral hemi-plates lined with buccal mucosal graft (BMG) to treat these patients.

Methods: A multi-institutional retrospective review was conducted for patients that underwent this staged repair. Read More

J Urol 2022 07 25;208(1):128-134. Epub 2022 Feb 25.

University of California San Diego, San Diego, California.

Purpose: There are no established guidelines regarding management of antibiotics for patients specifically undergoing urethral reconstruction. Our aim was to minimize antibiotic use by following a standardized protocol in the pre-, peri- and postoperative setting, and adhere to American Urological Association antibiotic guidelines. We hypothesized that prolonged suppressive antibiotics post-urethroplasty does not prevent urinary tract infection and/or wound infection rates. Read More