Primary closure of the perineal wound after abdomino-perineal amputation for adenocarcinoma

This is a prospective study of primary closure of the perineum in 35 successive cases of abdomino-perineal amputation of the rectum for adenocarcinoma (January 1972 - December 1978). All operations are performed by the same surgeon in a one-team approach. In 33 patients the perineum is closed, and 32 patients are available for evaluation. In 66% of them the wound heals per primam. Very extensive and exenterative procedures do not lower the chances for success. In women the results are better than in men. They are even better after posterior vaginal wall resection and posterior exeneration (no failures). Early postoperative failures are usually due to bleeding; the late ones are caused by infection. The procedure is complicated by one death (81 years), one ureteral fistula (47 years) and one late perineal hernia which may be imputed to the method. Primary closure of the perineum appears to be a very feasible (33/35), usefull and rather safe procedure from which the patient has a lot to win and quite nothing to loose.