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

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.