title: Abdominoperineal resection and perineal colostomy for low rectal cancer. The Lazaro da Silva technique.
abstract: OBJECTIVE
  We sought to evaluate a new technique for creation of a continent perineal colostomy following abdominoperineal resection (APR) of the rectum for low rectal cancer.
  
  
  METHODS
  Nine selected patients with low rectal cancer (two males; median age, 55.6 years; classified as Dukes A, 6 patients and as Dukes B, 3 patients) underwent APR. Following this, the original Lazaro da Silva technique was used as follows: 1) for performance of three circular myotomies in the distal sigmoid with a distance between each couple of no more than 8 cm; 2) repair of the myotomies, thus creating three circular colonic valves, the most distal of which remained extraperitoneally; 3) for construction of a perineal colostomy lying flush with the perineal skin; 4) after the patient starts consuming a regular diet, enemas through the perineal stoma are done, usually twice per week, to achieve defecation. Functional outcome was assessed by evaluation of bowel movements and neoanal continence.
  
  
  RESULTS
  There were no deaths. From January 1994 until October 1995, no tumor recurrence has occurred, and fecal continence has been good. Four of the patients were able to defecate without enemas (2-4 times per week), and in five patients the self-administration of enemas (2-4 times a week) were necessary to accomplish defecation.
  
  
  CONCLUSIONS
  Initial results with the Lazaro da Silva technique have been encouraging.
authors.affiliation: Department of Emergency Surgery, Military Medical Academy, Sofia, Bulgaria.
authors.forename: N G
authors.initials: NG
authors.lastname: Velitchkov
authors.forename: G K
authors.initials: GK
authors.lastname: Kirov
authors.forename: J E
authors.initials: JE
authors.lastname: Losanoff
authors.forename: K T
authors.initials: KT
authors.lastname: Kjossev
authors.forename: G I
authors.initials: GI
authors.lastname: Grigorov
authors.forename: M B
authors.initials: MB
authors.lastname: Mironov
authors.forename: I S
authors.initials: IS
authors.lastname: Klenov
mesh_terms: D000005:Abdomen / Q000601:surgery; D000368:Aged; D012809:Colon, Sigmoid / Q000601:surgery*; D003125:Colostomy / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010537:Peritoneum / Q000601:surgery; D012004:Rectal Neoplasms / Q000601:surgery*