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Methods to decrease the morbidity of abdominoperineal resection

H Farid1, T X O'Connell

  • 1Department of Surgery, Kaiser Permanente Medical Center, Los Angeles, CA 90027, USA.

The American Surgeon
|December 1, 1995
PubMed
Summary
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Abdominoperineal resections (APR) can achieve high primary healing rates with primary wound closure and suction catheters. Early self-catheterization reduces urinary retention complications, though prior radiation increases dehiscence risk.

Area of Science:

  • Colorectal Surgery
  • Surgical Oncology

Background:

  • Abdominoperineal resections (APR) are frequently linked to significant complications.
  • These complications include hemorrhage, prolonged hospitalization, and delayed healing of perineal wounds.

Purpose of the Study:

  • To evaluate the outcomes of abdominoperineal resections (APR) for cancer treatment.
  • To assess the efficacy of primary perineal wound closure with suction catheters.
  • To identify factors influencing complication rates, such as prior radiation therapy.

Main Methods:

  • Retrospective analysis of 35 patients undergoing APR for cancer between 1989 and 1993.
  • Implementation of primary perineal wound closure with closed system suction catheters in most patients.
  • Monitoring for complications, including wound healing, urinary retention, and operative outcomes.

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Main Results:

  • Successful primary healing was achieved in 91% of patients.
  • Perineal wound dehiscence occurred in 8.5% of patients.
  • Overall morbidity was 55%, with urinary retention (23%) being most common, managed by self-catheterization.
  • Patients with prior radiation therapy had a higher rate of wound dehiscence (40%) compared to those without (3.3%).

Conclusions:

  • Abdominoperineal resections can be performed with low mortality.
  • Primary closure of the perineal wound and early self-catheterization significantly reduce complications.
  • Prior radiation therapy is associated with increased morbidity, particularly perineal wound complications.