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A J Senagore

Publications and source records attributed to A J Senagore.

At least 55 records · Page 3Linked to original sources
PubMed1995

Operative repair of anovaginal and rectovaginal fistulas.

PURPOSE: Operative repair of low rectovaginal fistulas should be tailored to the specific anatomic defect. Endoanal flap repair frequently provides successful fistula closure; however, if substantial injury to the perineal body, anal sphincter, or rectovaginal septum exists, a more extensive repair is required. We present our experience with 95 consecutive patients, operated for rectovaginal fistulas via septal repair after conversion to a fourth degree perineal laceration, endoanal flap, or anoperineorrhaphy. METHODS: A retrospective chart review was performed. Data collected included etiology, location, size, repair type, and degree of anal continence. All patients received standard mechanical and antibiotic bowel preparation and parenteral antibiotics. No covering stomas were used. RESULTS: Fistula etiology included obstetric injury (N = 77), perianal cryptoglandular infection (N = 15), and other (N = 3). Thirty-one patients had previous unsuccessful repairs. Types of repairs were fourth degree perineal laceration (38), endoanal flap (19), and anoperineorrhaphy (38). Excellent or good functional results occurred in 92 patients (97 percent). Similar success occurred in patients with previous failed repairs (90 percent excellent or good). The recurrence rate was 3 percent. There were no outcome differences between techniques. CONCLUSION: We believe that all three types of repair for rectovaginal fistulas result in a high cure rate, thereby allowing operative technique to be tailored to the anatomic defects present. This approach should allow for optimal functional outcome.

Adult↗
PubMed1995

Superior nitrogen balance after laparoscopic-assisted colectomy.

BACKGROUND: Although early resumption of enteral feeding after gastrointestinal surgery results in improved nitrogen balance and lower infectious complications, no postoperative nutritional data after laparoscopic-assisted colectomy exists. OBJECTIVE: The authors prospectively compared nitrogen balance after laparoscopic-assisted colectomy versus open colectomy. METHODS: This is a series of colon resections (open, N = 10; laparoscopic-assisted, N = 9) at the Ferguson-Blodgett Hospital, Grand Rapids, Michigan, between January and March 1993. Nitrogen intake and 24-hour urine collections were performed on postoperative days 1, 3, and 7 for the analysis of total urinary nitrogen and urinary 3 methylhistidine-(3mH). RESULTS: The time to passage of flatus (4.7 +/- 0.6; 2.0 +/- 0.2), resumption of oral intake (6.1 +/- 0.7; 1.4 +/- 0.2; p < 0.05, Student's test), first bowel movement (5.2 +/- 1.0; 3.0 +/- 0.3; p < 0.05, Student;s t test), and discharge (10.3 +/- 1.3; 4.1 +/- 1.8; p < 0.05, Student's t test) occurred significantly earlier in the laparoscopic-assisted colectomy group. Overall hospital charges were lower in the laparoscopic-assisted colectomy group ($11,572 +/- $823 vs. $13,961 +/- $1050). The operative time was higher in the laparoscopic-assisted colectomy group (176 +/- 12 hours vs. 105 +/- 17 hours, p < 0.05,Student's test). Blood loss was higher in the open group (805 +/- 264 mL vs 217 +/- 32 mL, p < 0.05, Student's test). Urinary nitrogen losses were similar between the two groups; however, significantly more patients in the laparoscopic-assisted colectomy group achieved net positive nitrogen on day 3 (6/9; 0/10; p < 0.05, Fisher's exact test), and day 7 (9/9; 4/10; p < 0.05, Fisher's exact test). Infectious complications occurred less frequently in the laparoscopic-assisted colectomy group (0/9 vs. 4/10; p < 0.05, Fisher's exact test). CONCLUSIONS: Patients undergoing laparoscopic-assisted colectomy can achieve early resumption of enteral nutrition with earlier return to positive nitrogen balance compared with open colectomy. This may offer benefits of fewer infectious complications and lower cost of care.

Colectomy↗
PubMed1995

What is the learning curve for laparoscopic colectomy?

Learning curves have been described for a variety of laparoscopic procedures including cholecystectomy, tubal ligation, and diagnostic laparoscopy. Although multiple series of laparoscopic colectomies have appeared, there is little information regarding the learning curve associated with this advanced procedure. The purpose of this study is to present a single team's experience with laparoscopic colon resection to allow the description of our learning curve. The data collected included age, sex, operating room time, recovery of bowel function, days to clear liquid, hospital stay, conversion, complications, indication for operation, and site of resection. Sixty consecutive patients were analyzed and divided into three groups: First 20, Second 20, and Third 20. There were no significant differences between the three groups with respect to age, male versus female ratio, indications for surgery, or site of resection. However, the complexity of surgical procedures and the incidence of previous major abdominal surgery increased steadily with experience. The incidence of pulmonary complications was 30 per cent in the First 20 group and decreased to 5 per cent for the next two groups. The conversion rate was 20 per cent for the First 20 group, 45 per cent for the Second 20 group, and decreased to 10 per cent for the Third 20 group.(ABSTRACT TRUNCATED AT 250 WORDS)

Abdomen↗
PubMed1994

Methods to prevent colonic injury in pelvic radiation.

PURPOSE: Radiation has become an adjunct in the treatment of pelvic malignancies. Attempts to prevent adjacent tissue injury have met with varying degrees of success, and the purpose of this study was to investigate potential radioprotective effects of an elemental diet, sodium meclofenamate, and vitamin A in an animal model of acute and chronic pelvic radiation previously described. METHODS: Female Sprague-Dawley rats, 200-250 grams, were anesthetized and then received 900 rads of pelvic radiation once per week for five weeks for a total of 4500 rads. Animals were divided into five groups. Treatment groups received radiation and elemental diet, radiation and vitamin A, radiation and sodium meclofenamate. Control animals received anesthesia only and no radiation. Vitamin A was given as a supplement to (662 IU/kg) standard rat chow. Elemental diet was given as a commercially available formula, whereas sodium meclofenamate was given as a postoperative supplement (5 mg/kg/day). All animals were given these treatments during the course of radiation therapy only. Histology of distal colon was measured at one week, five weeks, six months, and one year postradiation therapy. The distal two cm of colon were removed at necropsy and fixed in 10 percent formalin at each of the above time points. Histologic grade was determined by a previously described grading scale. RESULTS: Results showed a qualitative radiation injury that could be documented at one and five weeks postradiation. Elemental diet, vitamin A, and sodium meclofenamate prevented histologic changes that occurred at these time points. No difference in histologic grade was seen between any groups at six months and one year postradiation therapy. CONCLUSION: In summary, our model of pelvic radiation produces a definable radiation injury within the colon at one and five weeks postradiation. Use of elemental diet, vitamin A, and sodium meclofenamate prevented these changes.

Acute Disease↗
PubMed1994

Interleukin-6 response to laparoscopic and open colectomy.

PURPOSE: It has been postulated that cortisol and interleukin-6 play a significant role in the modulation of the early inflammatory response following surgical intervention. There are no available data on the normal responses of these mediators following major laparoscopic procedures. The purpose of this study was to assess changes in cortisol (by fluorescence polarization immunoassay), interleukin-6 (by enzyme-linked immunoassay), and interleukin-1 (by enzyme-linked immunoassay) after elective laparoscopic colon resections. METHODS: All patients undergoing colon resection between February 1, 1992 and April 30, 1992 were eligible for study. Selection of laparoscopic (N = 12) vs. open (N = 41) resection was determined by the attending surgeon. All patients received a standard general anesthetic with endotracheal intubation. Cortisol, interleukin-6, and interleukin-1 were measured at preinduction, 1 hour, 2 hours, 3 hours, 4 hours, and 5 hours after the induction. Interleukin-6 and interleukin-1 were additionally measured at 12 hours, 24 hours, and 72 hours after induction. Comparisons were made between the laparoscopic patients (N = 12) and age, sex, and operation-matched open patients (N = 12). RESULTS: Cortisol levels rose in the early postoperative period in both open and laparoscopic groups with no significant differences occurring between the cohorts at any of the measured time intervals. The interleukin-6 levels of the laparoscopic cohort (N = 12) were significantly lower than those of the open cohort (N = 12) between 3 and 24 hours postinduction (P < 0.05). Interleukin-1 levels remained undetectable in virtually all patients irrespective of operative technique or postoperative interval. There was no correlation between peak interleukin-6 levels and operative times (laparoscopic, r = 0.31; open, r = 0.36) or blood loss (laparoscopic, r = 0.10; open, r = 0.20). CONCLUSION: The results indicate that laparoscopic colon resections do not appear to alter cortisol or interleukin-1 responses when compared with open colon resection. There is, however, a significant blunting of the interleukin-6 response associated with the use of laparoscopic techniques for colectomy compared with standard laparotomy.

Blood Loss, Surgical↗
PubMed1994

Intrarectal and intra-anal ultrasonography in the evaluation of colorectal pathology.

Recent advances in ultrasonography have improved significantly the accuracy and applicability of this technology to the management of anorectal pathology. Intrarectal ultrasonography has demonstrated a high degree of accuracy in the assessment of extent of local invasion of rectal carcinomas as well as the degree of regional lymph adenopathy. It also is capable of playing a significant role in the management of anorectal suppurative disorders by allowing identification of deep-seeded abscesses. This technology will play an expanding role in the management of anorectal disorders and should be in the armamentarium of the surgeon managing these problems.

Colonic Diseases↗
PubMed1994

An initial experience with lighted ureteral catheters during laparoscopic colectomy.

Ureteral catheters are recommended when a difficult pelvic dissection is anticipated to minimize the risk of ureteral injuries. With the introduction of laparoscopic-assisted colectomy, it has become necessary to replace tactile with visual feedback. Lighted ureteral catheters (LUC) have been advocated for major laparoscopic pelvic surgery as a means of enhancing ureteral identification. However, the use of LUC has been anecdotal to this point. We present the first series of selectively used LUC during laparoscopic-assisted colectomy. Forty-nine consecutive laparoscopic-assisted colectomies were reviewed in which patients had LUC placed or not (NC) [LUC,24(49%); NC, 25(51%)]. Indications for catheter insertion included complicated diverticular disease, previous pelvic surgery, and obesity. The need for LUC was at the discretion of the surgeon. Data collected included catheter visualization, type of procedure, operative time, operating room cost, and catheter or ureteral complications. Catheters were visualized in 5 of 6 (83%) right colectomies and 15 of 18 (83%) left colectomies. Nonvisualization was because of migration to the bladder (2 cases) and dense inflammatory reaction (2 cases). No catheter complications or ureteral injuries occurred in either group. Operative time (LUC, 192 +/- 11.3 min, NC, 161.4 +/- 9.5 min) was significantly longer in the LUC group as a result of the time for catheter insertion and the greater complexity of the case. The operating room cost was similar in the two groups (LUC, $3488.63 +/- 259.01; NC, $3537.56 +/- 313.43). The results indicate that selected use of LUC does significantly increase operating time without significantly increasing operating room cost or operative morbidity.(ABSTRACT TRUNCATED AT 250 WORDS)

Colectomy↗
PubMed1993

Rectopexy.

Many surgical procedures have been described for the management of full-thickness rectal prolapse. Currently, the three procedures most frequently used are anterior resection with or without suture rectopexy, transabdominal mesh fixation without resection, and perineal proctosigmoidectomy. Only the latter procedure avoids a laparotomy, and the mesh fixation technique has a high incidence of severe constipation postoperatively. Recently, there have been two reports of laparoscopic mesh fixation for rectal prolapse which were successful. However, the long-term concerns are probably very similar. Therefore, the purpose of this paper is to report a series of 6 laparoscopic-assisted anterior resections performed for rectal prolapse at Ferguson-Blodgett Hospital from January 1, 1992 through October 30, 1992. There were no perioperative mortalities and the only complication was a port site bleed which required re-exploration. The mean time for resumption of oral intake was 2.75 +/- 1.5 days and the length of hospital stay was 4.0 +/- 0.8 days. No early recurrences (< 1 yr) have been noted in this series. The authors feel that laparoscopic-assisted anterior resection is a safe and effective method of treating full-thickness rectal prolapse, thereby avoiding a laparotomy and reducing hospital stay.

Adult↗
PubMed1993

Open colectomy versus laparoscopic colectomy: are there differences?

Laparoscopic colectomy has been increasingly reported as an option for the treatment of colonic pathology. However, there is very little information regarding perioperative morbidity and the cost effectiveness of this technique. The purpose of this study is to review our first year of experience with laparoscopic colon resection. Data collected includes: age, technique (open laparotomy, laparoscopic, laparoscopic/converted open), Karnofsky score, complications, specimen size/nodes, OR time, hospital stay, and cost. This is a consecutive series of 140 elective colonic resections including 102 open laparotomies (O) and 38 laparoscopic (L) cases. The indications for surgery have included adenocarcinoma col/rect (O = 59, L = 9), diverticular disease (O = 10, L = 10), adenomatous polyp (O = 3, L = 7), IBD (Crohn's, CUC) (O = 15, L = 4), rectal prolapse (O = 3, L = 4), and other (O = 12, L = 4). There were no significant differences with respect to age (O = 60.7 +/- 1.5; L = 54.8 +/- 3.8; C = 66.1 +/- 3.1), perioperative morbidity (O = 11%; L = 15%; C = 17%). The laparoscopic and laparoscopic converted cases required significantly more time compared to the open laparotomy group (O = 2.1 +/- 0.2 hours; L = 2.9 +/- 0.2; C = 3.4 +/- 0.2). There were significantly less intraoperative blood loss associated with laparoscopic procedures compared with either open or converted groups of patients (O = 687 +/- 54 cc; L = 157 +/- 19; C = 491 +/- 50).(ABSTRACT TRUNCATED AT 250 WORDS)

Activities of Daily Living↗
PubMed1993

Ketorolac and patient controlled analgesia in the treatment of postoperative pain.

Ketorolac tromethamine (Toradol [Syntex, Palo Alto]), a new commercially available nonsteroidal antiinflammatory drug (NSAID), has appropriate solubility and minimal tissue irritation, making it suitable for intramuscular injection. Previously, NSAID have only been available for oral use in the United States for the treatment of pain. Ketorolac, the most potent NSAID known, relieves pain through inhibition of arachidonic acid synthesis at the cyclooxygenase level and has no central opioid effects. The results of previous studies using parenteral ketorolac in combination with patient administered narcotics have shown a 40 percent reduction in narcotic requirements. However, ketorolac is presently only approved for intramuscular injection and oral use in the United States. In a prospective, randomized study, we compared intramuscular ketorolac in combination with patient controlled intravenous narcotic analgesia (morphine) (PCA-M) to PCA-M alone for the control of pain after extensive colonic resections. The combination of intramuscular ketorolac and PCA-M provided equal pain relief with no increased side effects when compared with narcotics alone. However, narcotic requirements of the patients were decreased by an average of 45 percent. Ketorolac and narcotics in combination provide effective postoperative pain relief and significantly decrease narcotic requirements. This combination may be particularly beneficial in the subpopulation of patients especially prone to narcotic related complications.

Analgesia, Patient-Controlled↗
PubMed1992

Short-chain fatty acid enemas: a cost-effective alternative in the treatment of nonspecific proctosigmoiditis.

The purpose of this study was to perform a randomized, prospective comparison of corticosteroid enemas (CS--100 mg of hydrocortisone/60 cc P.R. q.h.s.; n = 12), mesalamine enemas (5-ASA--4 g/60 cc P.R. q.h.s.; n = 19), and short-chain fatty acid enemas (SCFA--60 cc P.R. b.i.d.; n = 14) for the treatment of proctosigmoiditis. Patients presenting to the Ferguson Clinic with the diagnosis of idiopathic proctosigmoiditis were evaluated for age, sex, prior history of proctitis, duration of symptoms prior to presentation, endoscopic scoring, and mucosal biopsies. Clinical evaluation was performed at two-week intervals for six weeks, with repeat biopsies taken at six weeks. There was no significant difference with respect to age, male/female ratio, past history of proctosigmoiditis, length of colorectum involved at the time of initial presentation, symptom resolution, and endoscopic and histologic improvement among the three treatment groups. Recovery occurred in a similar proportion in each of the three groups: CS, 10/12; 5-ASA, 17/19; and SCFA, 12/14. The cost of six weeks of treatment was: CS, $71.82; 5-ASA, $347.28; and SCFA, $31.50. This study indicates that SCFA enemas are equally efficacious to CS or 5-ASA enemas for the treatment of proctosigmoiditis at a significant cost savings.

Adult↗
PubMed1992

Adenosine triphosphate-magnesium chloride in radiation injury.

Although adenosine triphosphate-magnesium chloride (ATP-MgCl2) has demonstrated cytoprotective effects in a variety of adverse pathophysiologic conditions, its ability to alter radiation injury is unknown. The purpose of this study, therefore, was to assess the effects of ATP-MgCl2 on colorectal radiation injury after preoperative pelvic radiotherapy. Mixed-breed pigs (n = 36) received 4250 cGy preoperative external-beam pelvic radiotherapy (350 cGy fractions three times per week for 4 weeks). During radiotherapy, animals were randomly assigned to one of three treatment groups: (1) intravenous infusions of normal saline during radiotherapy, (2) intravenous ATP-MgCl2 (30 mumol/kg) during radiotherapy, or (3) intravenous ATP-MgCl2 (60 mumol/kg) during each radiotherapy session. After completion of radiotherapy and a 4-week rest period, animals underwent colorectal resection by either the two-layer hand-sewn (n = 18) or stapled end-to-end anastomosis technique (n = 18). Laser Doppler velocimetric readings were obtained to assess mural colonic blood flow after completion of anastomosis. A second laparotomy on postoperative day 5 or 11 was done to examine the following anastomotic parameters: (1) repeat laser Doppler velocimetry, (2) gross inflammatory scoring, (3) bursting pressure, (4) preoperative barium enema to identify leak or stenosis, (5) analysis of anastomotic hydroxyproline content, and (6) incidence of cutaneous injury in the radiation portals. ATP-MgCl2 administered intravenously at 60 mumol/kg led to (1) diminished colorectal seromuscular ischemia evidenced by laser Doppler velocimetric readings, (2) decreased skin and subcutaneous tissue injury in the treatment portals, (3) significantly decreased perianastomotic inflammatory reaction, and (4) increased early hydroxyproline content. There was no significant difference in the incidence of leakage or stenosis between the study groups, nor was the anastomotic bursting strength significantly different between the treatment groups. Therefore the administration of ATP-MgCl2 (60 mumol/kg) appears to offer significant cytoprotection from preoperative pelvic radiation therapy.

Adenosine Triphosphate↗
PubMed1992

Epidural analgesia.

The most frequently used postoperative analgesia techniques are intramuscular injection (IM) and patient controlled analgesia (PCA). Recently, the use of epidural catheter injection (EPI) has been done with success. This study was done to prospectively compare these three techniques for postoperative analgesia after extensive operations upon the colon and rectum. Patients were randomized to one of three analgesia groups--IM, intramuscular morphine sulfate; PCA, patient controlled morphine sulfate, and EPI, epidural morphine sulfate. Data collected included age, time to first bowel movement, amount of narcotic, number achieving 75 per cent of preoperative forced vital capacity, postoperative pruritus, headache, nausea and vomiting, respiratory depression, atelectasis or pneumonitis. A visual analog pain scale was used to evaluate postoperative pain severity (0, no; 1, partial; 2, marked, and 3, total relief). Sixty-eight patients were eligible for study (IM, 19; PCA, 22; EPI, 23, and excluded, four). The EPI group required significantly less daily narcotic compared with either the IM or PCA groups (17.0 +/- 6.12 milligrams; 67.8 +/- 26.8 milligrams; 40.5 +/- 20.6 milligrams, respectively, less than 0.05 ANOVA) and total narcotic (81.3 +/- 31.3 milligrams; 355.4 +/- 147.7 milligrams; 215.3 +/- 105.4 milligrams, respectively, p less than 0.05 ANOVA). EPI achieves excellent pain control in more patients with a significantly lower dose of narcotics and significantly fewer pulmonary complications. Therefore, epidural analgesia is the optimal method of postoperative analgesia after extensive abdominal operations.

Adult↗
PubMed1991

Transanal excision of large, rectal villous adenomas.

The purpose of this study is to demonstrate that a transanal excisional approach can be successfully used in most cases of large, benign, rectal villous adenomas with acceptable rates of recurrence and complications in comparison with historic controls. A retrospective review of all cases of benign, large, rectal villous adenomas at this institution from 1975 to 1985 was performed. A total of 122 patients had large, benign, rectal villous adenomas excised. All except five were treated by transanal excision. Thirty-eight percent of lesions were more proximal than 8 cm from the anal verge. The average follow-up was 55 months. Twenty-seven percent of patients were treated for residual disease after a known incomplete initial treatment or an adenoma at the same location within 6 months of the original treatment. Thirty percent of patients were treated for recurrent adenoma 6 months after complete initial treatment. Two patients (1.7 percent) with recurrences were found to have invasive carcinoma. Both patients had excisional therapy, and one had additional radiation therapy for these carcinomas. Ten postoperative hemorrhages and two perforations occurred as symptomatic or serious complications. This renders a 10 percent complication rate for the study group, which is lower than reported by others using the Kraske or trans-sphincteric approach to the rectum. Because of the expected higher recurrence rate, regular follow-up is necessary for this type of therapy. In conclusion, this study demonstrated that transanal excision of large, benign, rectal villous adenomas can be a safe and effective method of treatment.

Adenoma↗
PubMed1991

Does alpha sympathetic blockade prevent urinary retention following anorectal surgery?

Urinary retention is the most common complication after anorectal surgery, with rates as high as 52 percent reported. With the trend toward early discharge, avoidance of this complication is particularly important. Perioperative fluid restriction and the use of short-acting anesthetics have been shown to be effective in decreasing postoperative urinary retention rates but are not applicable in all cases. Reflex sympathetic stimulation, possibly as a result of perianal pain, may lead to increased muscular tone of the internal sphincter at the bladder neck. This theory had led to the effective use of alpha-adrenergic blockade in the treatment of established cases of urinary retention after anorectal surgery, herniorrhaphy, and major pelvic surgery. However, the prophylactic role of alpha blockade after anorectal surgery has not been studied. In a double-blind, prospective, randomized study, 51 patients were treated with either prazosin and alpha-adrenergic blocker or placebo prior to and immediately after elective anorectal surgery. Urinary retention rates were similar in the two groups. At this time, prophylactic alpha-adrenergic blockade is not recommended for the prevention of urinary retention after anorectal surgery.

Anal Canal↗
PubMed1991

Role of carcinoembryonic antigen and liver function tests in the detection of recurrent colorectal carcinoma.

The optimal laboratory evaluation for the early detection of liver metastases from colorectal cancer is controversial. This investigation was undertaken to compare the efficacy of liver function tests (LFTs) with that of carcinoembryonic antigen (CEA) levels for the early detection of liver metastases. Patients who developed liver metastases after potentially curative resections of adenocarcinoma of the colorectum between 1974 and 1988 were reviewed. The following laboratory tests were serially evaluated during the follow-up period: CEA, alkaline phosphatase (AP), serum glutamic oxaloacetic transaminase (SGOT), serum glutamic pyruvic transaminase (SGPT), and lactic dehydrogenase (LDH). These values were retrospectively assessed from the time of documented liver metastases to identify which lab value(s) were elevated initially. Ninety-two patients were available for study. Average time for the occurrence of liver metastases was 20 months (range, 3-72 months). The incidence of elevation of individual tests at the time of suspicion of liver metastasis was: CEA, 94.6 percent (P less than 0.25, chi-squared); AP, 18.5 percent; SGOT, 12.0 percent; SGPT, 5.4 percent; and LDH, 29.3 percent. When comparing CEA with a battery of LFTs at the time of suspicion of liver metastasis, CEA was elevated with normal LFTs in 64.1 percent (P less than 0.05, chi-squared), the most frequent occurrence. At least one LFT was elevated with a normal CEA in only 2.2 percent; CEA and at least one LFT were increased in 30.4 percent; and both tests were normal in only 3.3 percent. These results indicate that, of the individual laboratory tests performed, CEA elevation heralds liver metastases significantly more frequently. LDH is the liver function test most frequently elevated when liver metastases are first suspected. When CEA is directly compared with a battery of LFTs, CEA is statistically significantly more frequently elevated. In fact, suspicion of liver metastases would have been delayed by the omission of LFTs in only 2.2 percent of patients. Therefore, we conclude that LFTs should be deleted from the follow-up of colorectal cancer patients, decreasing costs without significantly decreasing accuracy.

Adenocarcinoma↗
PubMed1991

The bottom end. Handling of the perineal wound after abdominoperineal resection.

There are a number of options for handling the perineal wound following abdominoperineal resection, including open packing or primary closure with suction drainage. Open packing has not been widely accepted, fearing that it may delay perineal wound healing. The purpose of this paper, therefore, was to retrospectively evaluate, the experience at Ferguson Hospital with abdominoperineal resection from 1977 through 1986. The study population consisted of 288 patients undergoing abdominoperineal resection for rectal adenocarcinoma. Forty-six patients had the perineal wound closed primarily and 242 had the perineal wound packed open. Ninety-four patients had the pelvic peritoneum left open and 194 underwent closure of the pelvic peritoneum. Overall operative mortality was 2.1 per cent, and there was no significant difference between primary closure and open packing of the perineal wound with respect to hospital stay, operating time, operative blood loss, perioperative mortality, incidence of postoperative bowel obstruction, incidence of postoperative complications, or average time for perineal wound healing. Therefore, it would appear that packing the perineal wound following abdominoperineal resection is a viable means of handling the bottom end.

Adenocarcinoma↗