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Extended APER leaves a large defect in the perineum often filled with a myocutaneous flap. This increases operative time, morbidity and often requires plastic surgery. We report our early experience of repairing the perineal wound with biomesh.Between October 2008 and December 2009 five patients undergoing extended APER had a reconstruction of their pelvic floor using surgiSIS® biological mesh. All cases involved low rectal tumours of stage T2 to T4. In three cases, surgery followed long coursepre-operative radiotherapy.The biological mesh was successfully used in all five cases. Two patients had post-operative wound collections; these were superficial to and did not involve the biomesh. A third patient was experiencing perineal pain one year post-operatively; investigation revealed no mesh infection or other cause. There were no other adverse effects and all patients have subsequently made a good recovery. The median total anaesthetic time was 4 hours 30 mins. Median post-operative hospital stay was 10 days.Biological mesh offers an alternative method for perineal closure following extended APER. Thepresence of a plastic surgeon is not required, operative time is reduced and flap complications are avoided. Further study is required to evaluate this technique against the currently used methods.