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Methods to decrease the morbidity of abdominoperineal resection
1Department of Surgery, Kaiser Permanente Medical Center, Los Angeles, CA 90027, USA.
Abstract:
Recent reports stress that abdominoperineal resections (APR) are associated with many complications, including hemorrhage, long hospitalization, and delayed closure of an open perineal wound. Thirty-five patients underwent an abdominoperineal resection for cancer at Kaiser Permanente Medical Center, Los Angeles, from January 1989 to December 1993. All patients, except two, had their perineal wound closed after closure of the peritoneum and insertion of closed system suction catheters. Ninety-one per cent of patients achieved successful primary healing. Three patients (8.5%) suffered perineal wound dehiscence. Overall morbidity was 55 per cent, with urinary retention being the most common, occurring in 23 per cent of patients. This was managed successfully by early in-and-out self catheterization. There was no incidence of urinary tract infections. There were no operative deaths. Length of stay averaged 8.6 days, with a median of 7 days. Five patients had previous radiation therapy. Of those, two (40%) had perineal wound dehiscence, compared to only one of 33 (3.3%) patients without previous radiation. APRs can be done with minimal mortality, although with an increased morbidity in irradiated patients. Primary closure and drainage of the perineal wound significantly lowers the complication rate, as does early Foley removal and self in-and-out catheterization.
Insights
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.
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.