[Management of the perineal wounds after abdominoperineal resection: simple drainage only or with continuous irrigation?].
OBJECTIVE
To compare the effects of presacral irrigation and simple drainage on the perineal wound healing in patients after abdominoperineal resection (APR).


METHODS
From October 2004 to August 2009, patients with rectal cancer, ulcerative colitis or rectal gastrointestinal stromal tumor, who underwent APR or proctocolectomy, were randomized into two arms: simple drainage group (n = 37) and continuous irrigation (n = 37). Patients randomized to arm B received simple drainage only to presacral space; while those patients in arm A received continuous irrigation in addition to simple drainage. Perineal wound healing was taken as endpoint of this study. Major complication was defined as wound dehiscence or wound infection that the perineal wound should be reopened for drainage. Minor complication was defined as delayed healing wound with seroma or hematoma.


RESULTS
A total of 74 patients were enrolled in present study, with 37 patients in each arm, and there were 12 cases and 10 cases who received preoperative radiation therapy, respectively. In the arm A, 2 patients developed major complications, 3 patients incurred with minor complications and 32 patients got primary healing of the perineal wounds. In arm B, 8 patients suffered major complications, 3 patients incurred with minor complications and 26 patients got primary healing of the perineal wounds. The incidence of major complication was significantly lower in arm A (5.4% vs.21.6%, P = 0.042). Patients received preoperative radiation therapy had significantly higher rate of minor complications than patients underwent surgery only (18.2% vs. 3.9%, P = 0.039).


CONCLUSIONS
Simple drainage with continuous irrigation of the presacral space, in patients with abdominoperineal resection or proctocolectomy, could significantly lower the incidence of major complication and improve wound healing for perineal wound when compared with simple drainage only. Preoperative radiation therapy tends to increase the incidence of minor complications.
Department of General Surgery, Peking Union Medical College Hospital, Beijing 100730, China.
Yi
Y
Xiao
Guan-Nan
GN
Zhang
Bin
B
Wu
Guo-le
GL
Lin
Wen-Ming
WM
Wu
Lai
L
Xu
Hui-Zhong
HZ
Qiu
D000005:Abdomen / Q000601:surgery; D000368:Aged; D004322:Drainage / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010502:Perineum / Q000601:surgery*; D011184:Postoperative Period; D011446:Prospective Studies; D012004:Rectal Neoplasms / Q000601:surgery; D012007:Rectum / Q000601:surgery*; D013529:Surgical Wound Dehiscence / Q000517:prevention & control; D013530:Surgical Wound Infection / Q000517:prevention & control; D007507:Therapeutic Irrigation / Q000379:methods*; D014945:Wound Healing