Ommission of pelvic peritoneal closure after abdominoperineal rectal excision

Peritonealization of the raw areas and closure of the pelvic floor is sometimes impossible to perform in patients subjected to abdominoperineal rectal excision when combined with extensive lymph node clearance. The postoperative course in 34 patients, treated in that way, necessitating sacrifice of the peritoneum on the dorsal aspect of the abdominal wall and in the pelvis was studied with the possible relevances in mind. Complications requiring laparotomy in the early postoperative period, occurred in three patients, but in only one of the patients was the complication considered to be related to the omission of closing the pelvic floor. Admittedly, small intestinal obstruction complicated the postoperative course later on in another three patients, but it can hardly be excluded that this complication, caused by pelvic recurrence, should not have occurred if pelvic closure had been performed. It is concluded that the importance of peritonealization, covering all raw peritoneal surfaces and pelvic reconstruction, has been overstressed in the past. Moreover, it is also suggested that it is in fact better to leave the pelvic cavity widely open than to perform a reconstruction under tension, even in patients treated by conventional abdominoperineal resection for rectal carcinoma.