Perineal wound closure after abdomino-perineal excision of the rectum

Abstract

Wound infections have a significant impact on the postoperative morbidity after abdomino-perineal rectum resection (APR). However, the technique of perineal wound closure after APR has not been standardised yet. The prospective German multicentre trial "Colorectal Carcinoma (primary tumor)" (study I) enrolled 10 335 patients with rectal cancer over a time period from 1 January 2000 to 31 December 2002. The APR rate was 24.7% (n=2517). Four hundred and forty-five patients (17.6%) developed an infectious complication of the perineal incision. In contrast, the data of the reporting single centre participating in study I were as follows: patients with rectal cancer, n=206; APR, n=37; APR rate, n=18.0% (study II). In our surgical department, a standardised technique of perineal wound closure comprising tight sutures of the tissue in three layers (muscle, ischiorectal and subcutaneous fat), local administration of carriers releasing antibiotics and a redon drainage were used. Using these tools, the rate of septic perineal wound complications was considerably lower with 5.4% vs. 17.6% in the multicentre trial.

Low Rectal Cancer: Abdominoperineal Resection or Low Hartmann Resection? A Postoperative Outcome Analysis

“…This rate is slightly higher than the 17.6% perineal wound infection rate reported by Meyer et al 11 in a multicentric study with 2517 patients who underwent the Miles procedure. However, Heah et al 6 reported a 46% rate, but this percentage is really variable in the literature; in other studies, it is described to be up to 80%.…”

Low Incidence of Pelvic Sepsis after Hartmann’s Procedure: Radiation Therapy May Be a Risk Factor

“…Ultralow HP, where transection is performed above the anal canal, has been compared to abdominoperineal excision (APE). The advantages with HP are shorter operating time, less surgical trauma, and avoidance of a perineal wound [4, 5]. The disadvantage with HP is the high proportion (12–32%) of pelvic abscesses and sepsis [2, 5, 6].…”

An evolution of clinical application of inferior pedicle based rectus abdominis myocutaneous flap for repair of perineal defects after radical surgery for cancer

“…Surgical technique of perineal wound closure, after APR, depends on the preference of operating surgeon. In a cohort of 2,517 APR patients 445 (17.6%) developed infectious complication of perineal wound 50. A three layer primary closure—muscle, ischio‐rectal and sub‐cutaneous fat and skin 50, reduced the perineal wound infection rate to 5.4%.…”

“…In a cohort of 2,517 APR patients 445 (17.6%) developed infectious complication of perineal wound 50. A three layer primary closure—muscle, ischio‐rectal and sub‐cutaneous fat and skin 50, reduced the perineal wound infection rate to 5.4%. Nilsson et al 51 reported perineal wound infection in 13/35 (37.1%) patients undergoing salvage APR for recurrent or persistent epidermoid carcinoma anal canal.…”