Primary pelviperineal closure without drainage, after abdomino-perineal resection of the rectum--a comparative study.

Our personal experience in the management of the pelviperineal space, after proctectomy for cancer, with three different approaches is, retrospectively analyzed, attempting to define the most effective one (Jan. 1973 to Oct. 1982). Until June 1978 twenty five patients (Group A) underwent what we designate as Technique I (suturing the pelvic peritoneal layer and packing the pelviperineal wound open). From July 1978 to July 1980 Technique II (pelvic peritoneum left unsutured, pelviperineal wound primarily closed without drainage) was the approach in 16 patients (Group B), while Technique III (pelvic peritoneum sutured, primary perineal closure without drainage) was used in 18 patients (Group C) since then. The entire series consists of 57 patients with malignant tumors and 2 with invasive villous adenomas. No significant septic complications occurred among patients handled by primary perineal closure, all perineal wounds (Groups B and C), except one, healing per primam. A statistically significant higher incidence of small-gut obstruction was verified among patients of Group B, as compared to A and C (p = 0.05). The rate of thromboenbolic complications was much higher in Group A patients. The postoperative hospital stay and the length of time required for complete perineal healing were noticeably longer, therefore detracting from its cost effectiveness, among patients managed by technique I, as compared to II and, particularly, III. On the whole series there was one laporotomy wound infection (1.7 Vo), in one patient of Group C. No major intraperitoneal sepsis developed in any patient. One patient died of massive pulmonary embolism and another one from ulcerating, diffuse enterocolitis, both pertaining to Group A, for an overall operative mortality of 3.4 %. It is concluded that primary perineal closure with suturing of the pelvic peritoneal floor, without drainage, can be safely accomplished and may be considered the ideal management of the pelviperineal space after proctectomy for cancer.