title: Combination of pseudocontinent perineal colostomy and appendicostomy: a new approach in the treatment of low rectal cancer.
abstract: BACKGROUND
  Abdominal perineal resection (APR) with applied colostomy remains the standard treatment for low rectal cancer; however, to date, a very high morbidity rate has been reported.
  
  
  OBJECTIVE
  The aims of this study were to assess fecal continence, persistence of disease-related symptoms, and quality of life in patients with low rectal cancer after APR and pseudocontinent perineal colostomy and concomitant appendicostomy.
  
  
  METHODS
  We included 17 patients with low rectal cancer who underwent APR at our hospital in this cross-sectional study. Following APR, pseudocontinent perineal colostomy and concomitant appendicostomy were performed. Patients then underwent antegrade colonic enema with tap water. Patients' symptoms, fecal continence, and quality of life were evaluated at regular time intervals.
  
  
  RESULTS
  After a median follow-up of 12 months, 15 of 17 patients completed the study period. All patients were able to perform an antegrade enema by themselves. Mean continence score was 7 (out of 20) based on the Wexner Scale scoring system. Mean global health status score was 78, physical function was 93, and emotional function was 88. Minor morbidity was observed in 6 patients (40%).
  
  
  CONCLUSIONS
  Pseudocontinent perineal colostomy with appendicostomy provides an acceptable level of continence and functional and emotional improvement in patients with low rectal cancer undergoing APR. Hence, this combinative method could be considered as an alternative for abdominal colostomy in selected patients.
authors.affiliation: 1Rasoul-e-Akram Hospital, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Rasoul
authors.initials: R
authors.lastname: Azizi
authors.forename: Mina
authors.initials: M
authors.lastname: Alvandipour
authors.forename: Saeed
authors.initials: S
authors.lastname: Shoar
authors.forename: Bahar
authors.initials: B
authors.lastname: Mahjoubi
mesh_terms: D000328:Adult; D000368:Aged; D001065:Appendix / Q000601:surgery*; D003125:Colostomy / Q000009:adverse effects / Q000379:methods*; D003430:Cross-Sectional Studies; D005242:Fecal Incontinence / Q000209:etiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010502:Perineum / Q000601:surgery*; D011183:Postoperative Complications / Q000209:etiology; D012004:Rectal Neoplasms / Q000601:surgery*