Perineal pseudocontinent colostomy for ultra-low rectal adenocarcinoma: the muscular graft as a pseudosphincter

Souadka, Amine; Majbar, Mohammed Anass; Amrani, L.; Souadka, A.

doi:10.1080/00015458.2016.1174020

Cited by 7 publications

(7 citation statements)

References 14 publications

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“…The procedure is followed by an adequate intra hospital period dedicated to educating patients on the subsequent scheduled colonic irrigations. For the initial 3−4 postoperative days, the colonic irrigations are performed by the department nursing, who have a substantial expertise in the management of PCPC 16 . The colonic irrigations consist of a gradual instillation of warm water using an enema bock.…”

Section: Methodsmentioning

confidence: 99%

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From burden to relief: The economic and quality‐of‐life advantages of pseudo continent perineal colostomy in ultra‐low rectal cancer patients

Lahnaoui,

Essangri,

El bahaoui

et al. 2023

Journal of Surgical Oncology

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Background and ObjectivePseudo Continent Perineal Colostomy (PCPC) is an alternative technique to left iliac colostomy (LIC) after abdominoperineal resection for ultra low rectal cancer (ULRC). It allows placing the stoma in the perineum to preserve patients' body image. However, concerns about its impact on quality of life and management costs have limited its adoption. We aimed to compare the early outcomes and financial burden of PCPC and LIC in ULRC patients in Morocco, a low‐middle‐income country.MethodsFrom January 2018 to December 2019, all patients who underwent abdomino‐perineal resection (APR) with LIC or PCPC were prospectively enrolled. For each patient, baseline characteristics, and in hospital and 90 days morbidity with a focus on perineal complications were reported. Quality of life (QOL) was assessed using the validated EORTC‐C30 and CR29 questionnaires. Financial burden to patients was reported using declarative out‐of‐pocket costs (OOPC) analysis.ResultsAmong 49 patients who underwent APR, 33 received PCPC and 16 received definitive LIC. Similar rates of early perineal complications were observed between the two groups (p = 0.49). Readmission rate at POD90 was higher in the LIC‐group due to perineal sepsis (p = 0.09). QOL analysis at 6 months revealed that patients with PCPC had a higher global health status (p = 0.006), a better physical functioning and reported fewer symptoms of flatulence and fecal incontinence (p = 0.001). Patients with a LIC reported more financial difficulties with higher median OOPC of stoma management up to €23 versus €0 per month for PCPC (p = 0.0024). PCPC was the only predictive factor of improved patient reported outcomes.ConclusionsPCPC is a cost‐effective alternative to the standard definitive colostomy without alteration of the QOL or additional perineal complications during the first 6 months following the surgery. These findings may help convince surgeons to offer this option to patients refusing definitive LIC.

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Section: Methodsmentioning

confidence: 99%

“…For the initial 3−4 postoperative days, the colonic irrigations are performed by the department nursing, who have a substantial expertise in the management of PCPC. 16 The colonic irrigations consist of a gradual instillation of warm water using an enema bock.…”

Section: Surgical Proceduresmentioning

confidence: 99%

From burden to relief: The economic and quality‐of‐life advantages of pseudo continent perineal colostomy in ultra‐low rectal cancer patients

Lahnaoui,

Essangri,

El bahaoui

et al. 2023

Journal of Surgical Oncology

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“…[ 24 , 25 ] If a 1-cm distal margin could not be achieved, an abdominoperineal excision was performed, followed by either a left iliac colostomy or a pseudo-continent perineal colostomy. [ 20 , 23 , 26 , 27 ] The decision to convert to open surgery could only be confirmed after seeking the advice of the second surgeon.…”

Section: Methodsmentioning

confidence: 99%

The learning curve of laparoscopic rectal cancer surgery of millennial surgeons: Lessons for a safe implementation in low- and middle-income countries

Sekkat

Souadka

Alaoui³

et al. 2023

J Min Access Surg

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Objective: This study aimed to analyse the learning curve (LC) in laparoscopic rectal cancer resections of 2 millennial surgeons during the implementation of the first laparoscopic rectal cancer surgery programme in low- and middle-income country (LMIC) cancer centre. Methods: All consecutive patients operated by two millennial surgeons for primary rectal adenocarcinoma between January 2018 and March 2020 were included. The LC was analysed for operative duration and conversion to open surgery using both cumulative sum (CUSUM) and/or variable life-adjusted display (VLAD) charts. Results: Eighty-four patients were included, 45 (53.6%) men with a mean age of 57.3 years. Abdominoperineal resection was performed in 31 (36.9%) cases and resections were extended to other organs in 20 (23.8%) patients. Thirteen patients (15.5%) had conversion to open surgery. Using CUSUM, Learning curve based on conversion was completed at 12 cases for the first surgeon versus 10 cases for the second. While using VLAD and learning curve-CUSUM (LC-CUSUM), the cases needed were 26 vs 24 respectively. The median operative duration was 314 min with a LC completed at cases (17 vs. 26), and (18 vs. 29) using, respectively, standard and LC-CUSUM. Conclusions: This study shows a safe and short LC of millennial surgeons during the implementation of a laparoscopic rectal cancer surgery in an LMIC cancer centre, and the valuable use of modern statistical methods in the prospective assessment of LC safety during surgical training.

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“…The absolute priority, when discussing any reconstructive technique, is to always ensure that it does not compromise the oncological results of the original surgery. Several studies have shown that perineal colostomy not only does not compromise, but also facilitates more radical excisions, to ensure R0 results, by providing a reconstruction alternative [3,13,17]. Patient satisfaction rates are significantly better when compared to ostomy procedures, and they also tend to score higher on everyday functionality scores and quality of sexual life scores [5,7,10,11,18].…”

Section: Perineal Colostomy Advantagesmentioning

confidence: 99%

Perineal colostomy: advantages and disadvantages

Mulita¹,

Tepetes²,

Verras³

et al. 2022

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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. Although this method could be a good option in selected patients, physicians should always be aware of the disadvantages of perineal colostomy.

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Perineal pseudocontinent colostomy for ultra-low rectal adenocarcinoma: the muscular graft as a pseudosphincter

Abstract: This study showed that the musculae graft of Pseudocontinent Perineal colostomy acted as a hypotonic sphincter that pressure can increase during the voluntary squeeze. These data may help to clarify the functional outcomes of this technique after APR for ultra-low rectal adenocarcinoma.

Cited by 7 publications

References 14 publications

From burden to relief: The economic and quality‐of‐life advantages of pseudo continent perineal colostomy in ultra‐low rectal cancer patients

From burden to relief: The economic and quality‐of‐life advantages of pseudo continent perineal colostomy in ultra‐low rectal cancer patients

The learning curve of laparoscopic rectal cancer surgery of millennial surgeons: Lessons for a safe implementation in low- and middle-income countries

Perineal colostomy: advantages and disadvantages

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