Article

Primary Closure of the Posterior Wound After Combined Abdominoperineal Resection For Carcinoma of the Rectum

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Abstract

DESPITE the fact that most carcinomas of the lower sigmoid colon can now be resected safely and effectively with preservation of the rectum, the safest and most effective treatment of cancers located at or below the reflection of the peritoneum remains the combined abdominoperineal resection. This operation includes a wide resection of the rectum, the rectal stalks and part of the levator ani muscles.

Until recently we dealt with the posterior wound by packing it open, following the technic developed by Miles and Jones. Although the patients did well from the standpoint of mortality, early ambulation was hindered by the presence of the large pack. The dressing of the posterior wound required much time, caused considerable discomfort, and often drainage persisted for several months during which the patient required perineal dressings and periodic examinations to insure against the formation of an abscess.

Impressed by reports of others1, 2 who had partially closed the posterior wounds and left them drained only by a Penrose drain, we began in 1947 to close the wounds tightly by the following technic.

Technic

  1. Conventional Miles type of combined abdominoperineal resection following Jones’ modifications of technic, but mobilizing as much pelvic peritoneum as possible to help fill the dead space.

  2. Complete hemostasis of posterior wound by electrocoagulation or ligation of bleeding points with Number 60 cotton.

  3. Partial closure of stumps of levator ani muscles, fascia and fat, under tension if necessary, with 4 interrupted sutures of Number 31 stainless steel wire. This procedure. . .


 

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