Methods to decrease the morbidity of abdominoperineal resection.

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.