Asian Journal of Case Reports in Surgery

Bilateral Gluteal V-Y Fascio-Cutaneous Advancement Flap Reconstruction of the Perineal Defect following Laparoscopic Extra Levator Abdominoperineal Resection (ELAPR) for Advanced Lower Rectal Cancer with Malignant Perianal Fistula

Selvarajah Kokulan *

National Cancer Institute Maharagama, Sri Lanka.

Kanishka De Silva

National Cancer Institute Maharagama, Sri Lanka.

*Author to whom correspondence should be addressed.

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Abstract

Advanced lower rectal cancer may present with malignant perianal fistulae. When the fistulous tracts are extensive, achieving an adequate margin and covering the soft-tissue defect following perineal resection present a significant challenge.

We managed a male patient with locally advanced lower rectal cancer with recurrent perianal fistulae. After appropriate imaging and histological confirmation, he was treated with neoadjuvant long-course chemo-radiotherapy followed by Laparoscopic ELAP. The soft-tissue defect was covered with bilateral gluteal V-Y fascio-cutaneous advancement flap reconstruction. He recovered without significant complications and was discharged on post-op day 7. The specimen histology revealed an adequate pathological margin. He was started on adjuvant chemotherapy.

This case emphasises the feasibility of Laparoscopic ELAP with bilateral gluteal V-Y fascio-cutaneous advancement flap reconstruction for advanced lower rectal cancer with malignant perianal fistula.

Keywords: Bilateral gluteal, flap reconstruction, rectal cancer, perianal fistula

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