Purse string closure of perineal defects after abdominoperineal excision.
Abdomino-perineal resection
Perineal closure
Purse-string
Surgery site infection
Journal
Langenbeck's archives of surgery
ISSN: 1435-2451
Titre abrégé: Langenbecks Arch Surg
Pays: Germany
ID NLM: 9808285
Informations de publication
Date de publication:
15 Aug 2023
15 Aug 2023
Historique:
received:
13
02
2023
accepted:
03
08
2023
medline:
16
8
2023
pubmed:
15
8
2023
entrez:
14
8
2023
Statut:
epublish
Résumé
The aim of this study was to describe a new technique of perineal closure following abdominoperineal excision (APE) using purse-string perineal skin closure (PSPC). Between January 2016 and May 2021, 15 consecutives patients who had an APE procedure were included in this retrospective single-center study. All indications of APE were considered, as well as all types of APE. We analyzed the patient characteristics and peri-operative features, including overall (Clavien 1 to 5) and severe (Clavien 3 and 4) postoperative morbidity, length of stay (LOS), and long-term results (median time to perineal wound closure and rate of perineal incisional hernia). The patients included 11 men and four women, with a mean age of 64 ± 13 [33-80] years. The indication of APE was an epidermoid carcinoma of the anal canal (n = 5) or an adenocarcinoma of the rectum (n = 10). The mean operating time was 220 ± 88.64 [70-360] min. The overall morbidity rate was 60%, the severe morbidity rate 26%, and reoperation rate 26%. The median length of stay was 9 ± 6.5 days. After a mean follow-up of 23.5 ± 20.3 months, the median time to perineal wound closure was 96 ± 60 days, the persistent perineal sinus rate was 6% (n = 2), and one patient developed a perineal incisional hernia. Purse-string closure of perineal wounds is a safe and effective technique for perineal wound closure after APE. The short LOS allowed an early return home.
Identifiants
pubmed: 37580449
doi: 10.1007/s00423-023-03044-7
pii: 10.1007/s00423-023-03044-7
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
309Informations de copyright
© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.
Références
Heald RJ, Husband EM, Ryall RD (1982) The mesorectum in rectal cancer surgery–the clue to pelvic recurrence? Br J Surg 69(10):613–616
doi: 10.1002/bjs.1800691019
pubmed: 6751457
Bahadoer RR, Dijkstra EA, van Etten B, Marijnen CAM, Putter H, Kranenbarg EM et al (2021) Short-course radiotherapy followed by chemotherapy before total mesorectal excision (TME) versus preoperative chemoradiotherapy, TME, and optional adjuvant chemotherapy in locally advanced rectal cancer (RAPIDO): a randomised, open-label, phase 3 trial. Lancet Oncol 22(1):29–42
doi: 10.1016/S1470-2045(20)30555-6
pubmed: 33301740
Conroy T, Bosset JF, Etienne PL, Rio E, François É, Mesgouez-Nebout N et al (2021) Neoadjuvant chemotherapy with FOLFIRINOX and preoperative chemoradiotherapy for patients with locally advanced rectal cancer (UNICANCER-PRODIGE 23): a multicentre, randomised, open-label, phase 3 trial. Lancet Oncol 22(5):702–715
doi: 10.1016/S1470-2045(21)00079-6
pubmed: 33862000
Mauvais F, Sabbagh C, Brehant O, Viart L, Benhaim T, Fuks D et al (2011) The current abdominoperineal resection: oncological problems and surgical modifications for low rectal cancer. J Visc Surg 148(2):e85-93
doi: 10.1016/j.jviscsurg.2011.03.001
pubmed: 21481666
Musters GD, Klaver CEL, Bosker RJI, Burger JWA, van Duijvendijk P, van Etten B et al (2017) Biological mesh closure of the pelvic floor after extralevator abdominoperineal resection for rectal cancer: a multicenter randomized controlled trial (the BIOPEX-study). Ann Surg 265(6):1074–1081
doi: 10.1097/SLA.0000000000002020
pubmed: 27768621
Pemberton JH (2003) How to treat the persistent perineal sinus after rectal excision. Colorectal Dis 5(5):486–489
doi: 10.1046/j.1463-1318.2003.00520.x
pubmed: 12925086
Musters GD, Buskens CJ, Bemelman WA, Tanis PJ (2014) Perineal wound healing after abdominoperineal resection for rectal cancer: a systematic review and meta-analysis. Dis Colon Rectum 57(9):1129–1139
doi: 10.1097/DCR.0000000000000182
pubmed: 25101610
Banerjee A (1997) Pursestring skin closure after stoma reversal. Dis Colon Rectum 40(8):993–994
doi: 10.1007/BF02051210
pubmed: 9269819
Rondelli F, Franco L, BalzarottiCanger RC, Ceccarelli G, Becattini C, Bugiantella W (2018) Purse-string closure versus conventional primary closure of wound following stoma reversal: meta-analysis of randomized controlled trials. Int J Surg 52:208–213
doi: 10.1016/j.ijsu.2018.02.027
pubmed: 29474885
Sureshkumar S, Jubel K, Ali MS, Vijayakumar C, Amaranathan A, Sundaramoorthy S et al (2018) Comparing surgical site infection and scar cosmesis between conventional linear skin closure versus purse-string skin closure in stoma reversal - a randomized controlled trial. Cureus 10(2):e2181
pubmed: 29657907
pmcid: 5896871
Allart KK, Sabbagh C, Dhahri A, Badaoui R, Regimbeau JM (2021) Short-term outcomes of day-case stoma closure: a prospective, observational study. Dis Colon Rectum 64(11):1407–1416
doi: 10.1097/DCR.0000000000001905
pubmed: 33951687
James RD, Glynne-Jones R, Meadows HM, Cunningham D, Myint AS, Saunders MP et al (2013) Mitomycin or cisplatin chemoradiation with or without maintenance chemotherapy for treatment of squamous-cell carcinoma of the anus (ACT II): a randomised, phase 3, open-label, 2 × 2 factorial trial. Lancet Oncol 14(6):516–524
doi: 10.1016/S1470-2045(13)70086-X
pubmed: 23578724
Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240(2):205–213
doi: 10.1097/01.sla.0000133083.54934.ae
pubmed: 15273542
pmcid: 1360123
Blok RD, Sharabiany S, Ferrett CG, Hompes R, Tanis PJ, Cunningham C (2019) CT assessment of the quality of omentoplasty and its implications for perineal wound healing. Int J Colorectal Dis 34(11):1963–1970
doi: 10.1007/s00384-019-03412-0
pubmed: 31686200
Holm T, Ljung A, Häggmark T, Jurell G, Lagergren J (2007) Extended abdominoperineal resection with gluteus maximus flap reconstruction of the pelvic floor for rectal cancer. Br J Surg 94(2):232–238
doi: 10.1002/bjs.5489
pubmed: 17143848
Moore TJ, Moran BJ (2012) Precision surgery, precision terminology: the origins and meaning of ELAPE. Colorectal Dis 14(10):1173–1174
doi: 10.1111/j.1463-1318.2012.03082.x
pubmed: 22966814
Fingerhut A, Hay JM, Delalande JP, Paquet JC (1995) Passive vs closed suction drainage after perineal wound closure following abdominoperineal rectal excision for carcinoma. A multicenter, controlled trial. The French Association for Surgical Research. Dis Colon Rectum 38(9):926–32
doi: 10.1007/BF02049727
pubmed: 7656739
Schiller DE, Cummings BJ, Rai S, Le LW, Last L, Davey P et al (2007) Outcomes of salvage surgery for squamous cell carcinoma of the anal canal. Ann Surg Oncol 14(10):2780–2789
doi: 10.1245/s10434-007-9491-8
pubmed: 17638059
Devulapalli C, Jia Wei AT, DiBiagio JR, Baez ML, Baltodano PA, Seal SM et al (2016) Primary versus flap closure of perineal defects following oncologic resection: a systematic review and meta-analysis. Plast Reconstr Surg 137(5):1602–1613
doi: 10.1097/PRS.0000000000002107
pubmed: 26796372
Foster JD, Tou S, Curtis NJ, Smart NJ, Acheson A, Maxwell-Armstrong C et al (2018) Closure of the perineal defect after abdominoperineal excision for rectal adenocarcinoma - ACPGBI Position Statement. Colorectal Dis 20(Suppl 5):5–23
doi: 10.1111/codi.14348
pubmed: 30182511
Jones H, Moran B, Crane S, Hompes R, Cunningham C, group L (2017) The LOREC APE registry: operative technique, oncological outcome and perineal wound healing after abdominoperineal excision. Colorectal Dis. 19(2):172–80
doi: 10.1111/codi.13423
pubmed: 27321172
Shang A, Wang M, Yang Y, Zhao Z, Li D, Guo Y et al (2022) Transperineal pelvic drainage combined with lateral position to promote perineal wound healing after abdominoperineal resection: a prospective cohort trial. Medicine (Baltimore) 101(14):e29104
doi: 10.1097/MD.0000000000029104
pubmed: 35446293
Nisar PJ, Scott HJ (2009) Myocutaneous flap reconstruction of the pelvis after abdominoperineal excision. Colorectal Dis 11(8):806–816
doi: 10.1111/j.1463-1318.2008.01743.x
pubmed: 19055518
Tao Y, Han JG, Wang ZJ (2021) Comparison of perineal morbidity between biologic mesh reconstruction and primary closure following extralevator abdominoperineal excision: a systematic review and meta-analysis. Int J Colorectal Dis 36(5):893–902
doi: 10.1007/s00384-020-03820-7
pubmed: 33409565
Blok RD, Hagemans JAW, Klaver CEL, Hellinga J, van Etten B, Burger JWA et al (2020) A systematic review and meta-analysis on omentoplasty for the management of abdominoperineal defects in patients treated for cancer. Ann Surg 271(4):654–662
doi: 10.1097/SLA.0000000000003266
pubmed: 30921047