Primary Closure of the Posterior Wound After Combined Abdominoperineal Resection For Carcinoma of the Rectum

Crile, George; Robnett, Ausey H.

doi:10.3949/ccjm.17.1.5

Cited by 19 publications

(9 citation statements)

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“…[17][18][19] This was associated with prolonged healing time and PPS. Primary closure was accompanied by continuous postoperative irrigation of the wound through drains placed laterally to the midline perineal wound, not actually through the wound itself.…”

Section: Discussionmentioning

confidence: 99%

Factors affecting the healing of the perineum following surgery

Jones

Bassett

2013

annals

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North West London Hospitals NHS Trust, UK aBStract INTRODUCTION The aim of this study was to establish patient and procedural factors associated with the development of an unhealed perineum in patients undergoing a proctectomy or excision of an ileoanal pouch. METHODS A review of 194 case notes for procedures performed between 1997 and 2009 was carried out. All patients had at least 12 months' follow-up. Univariate and multivariate analyses were performed in 16 parameters. For those patients who developed an unhealed perineum, Cox regression analysis was performed to establish healing over a 12-month period. RESULTS Two hundred patients were included in the study, of which six had unknown wound status and were subsequently excluded. This left 194 study patients. Of these, 86 (44%) achieved primary wound healing with a fully healed perineum and 108 (56%) experienced primary wound failure. With reference to the latter, 63 (58%) healed by 12 months. Comparing patients with an initially intact perineum with those with initial wound failure showed pre-existing sepsis was highly relevant (odds ratio: 4.32, 95% confidence interval [CI]: 2.16-8.62, p<0.001). In patients who had an unhealed perineum initially, perineal sepsis and surgical treatment were both significantly associated with time to healing (hazard ratio [HR]: 0.54, p=0.03; and HR: 0.42, p=0.01). CONCLUSIONS The presence of pre-existing perineal sepsis is associated with an unhealed perineum following proctectomy in inflammatory bowel disease (IBD) and non-IBD surgery. Further studies are indicated to establish perineal sepsis as a causative factor.

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Section: Discussionmentioning

confidence: 99%

Factors affecting the healing of the perineum following surgery

Jones

Bassett

2013

annals

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“…From analyses of the data, the end point of healing of the perineal wound could be separated into four groups: (1) within three weeks, (2) between three weeks and three months, (3) between three months and one year, and (4) longer than one year. In the first group, the wound was completely healed within three weeks; occasionally, mini¬ mal serous drainage occurred, but there was no separation.…”

Section: Resultsmentioning

confidence: 99%

Healing of the Perineal Wound

Hartz¹,

Poticha²,

Shields³

1980

Arch Surg

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This audit has retrospectively assessed the result of primary closure of the perineum irrespective of risk factors for healing: pre-operative radiotherapy, faecal contamination, age, advanced malignancy and diabetes mellitus. 74 consecutive patients (49 males and 25 females median age 70 years) with rectal carcinoma (72) and anal carcinoma (2) who had undergone abdominal perineal excision from August 1989 to December 1999 were identified retrospectively. Complications of the perineal wound were tabulated. Fifty five of 74 patients (75%) healed primarily by two weeks and delayed healing occurred in 19 (25%) patients including 3 (4%) with complete dehiscence. Four of nine patients (45%) who received pre-operative radiotherapy achieved primary healing. Two of 32 patients (6%) who received post-operative radiotherapy after the perineal wound had healed developed wound complications. The primary healing rate of the advanced tumours Dukes ' stage B &C (74%) was similar to the overall healing rate. The average length of hospital f stay following primary healing was 12.25 days and 17.05 days following delayed healing. Other factors comparing tumour stage, sex, age and weight were not statistically significant. A technique of complete primary closure ("sealing") of the perineal wound by obliterating the perineal dead space over a transabdominal suction drain can provide a primary healing rate of 75% by two weeks irrespective of risk factors. Primary closure is safe and can be advised in most cases.

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“…Primary closure of the perineal wound was pioneered by Crile and Robnett (1950), who reported 78 per cent primary healing in patients with rectal cancer. Few have been able to better their results in spite of advances in bowel preparation, antibiotic therapy, drainage methods etc.…”

Section: Discussionmentioning

confidence: 99%

The results of vaginoplasty in excision of the rectum

Johnston

1979

Journal of British Surgery

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Vaginoplasty was used in a consecutive series of 45 patients undergoing rectal excision for neoplastic and inflammatory bowel disease. Forty-three patients achieved primary perineal healing and none developed a persistent perineal fistula. One patient with Crohn's disease developed a perianal fistula a year after operation but healing occurred after minor surgery. Another developed a pre-sacral abscess 9 years after operation; spontaneous discharge into the vagina occurred.

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Primary Closure of the Posterior Wound After Combined Abdominoperineal Resection For Carcinoma of the Rectum

Cited by 19 publications

References 0 publications

Factors affecting the healing of the perineum following surgery

Factors affecting the healing of the perineum following surgery

Healing of the Perineal Wound

The results of vaginoplasty in excision of the rectum

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