Skip to main content

Advertisement

SpringerLink
Log in

Pelvic peritoneum closure reduces postoperative complications of laparoscopic abdominoperineal resection: 6-year experience in single center

  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Background

To investigate feasibility of laparoscopic abdominoperineal resection with pelvic peritoneum closure (LAPR-PPC) for lower rectal cancer.

Methods

LAPR-PPC has been used for lower rectal cancer in our institution since 2014. In this study, we retrospectively analyzed the data from 86 patients who underwent LAPR-PPC and compared with the data from 96 patients who underwent laparoscopic APR without PPC (LAPR) from January 2013 to December 2018.

Results

The rate of perineal surgical site infection (SSI) (18.75% (18/96) vs. 5.81% (5/86), p < 0.01), delayed (> 4 weeks) perineal healing (12.50% (12/96) vs. 3.49% (3/86), p = 0.027), ileus (7.29% (7/96) vs 1.16% (1/86), p = 0.044), and postoperative perineal hernia (PPH, 5.21% (5/96) vs. 0% (0/86), p = 0.032) were significantly lower in LAPR-PPC group than LAPR group. The patients in LAPR-PPC group had shorter hospitalization time (21.32 ± 11.95 days vs. 13.93 ± 11.51 days, p < 0.01).

Conclusions

PPC procedure enabled the reduction in perineal wound complications, ileus, PPH, and consequently shortened hospitalization time. LAPR-PPC is beneficial for the patients with lower rectal cancer.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Fleshman J, Branda ME, Sargent DJ, Boller AM, George VV, Abbas MA, Peters WR Jr, Maun DC, Chang GJ, Herline A, Fichera A, Mutch MG, Wexner SD, Whiteford MH, Marks J, Birnbaum E, Margolin DA, Larson DW, Marcello PW, Posner MC, Read TE, Monson JRT, Wren SM, Pisters PWT, Nelson H (2019) Disease-free survival and local recurrence for laparoscopic resection compared with open resection of stage ii to iii rectal cancer: follow-up results of the ACOSOG Z6051 randomized controlled trial. Ann Surg 269:589–595

    Article  Google Scholar 

  2. Stevenson ARL, Solomon MJ, Brown CSB, Lumley JW, Hewett P, Clouston AD, Gebski VJ, Wilson K, Hague W, Simes J (2019) Disease-free survival and local recurrence after laparoscopic-assisted resection or open resection for rectal cancer: the Australasian laparoscopic cancer of the rectum randomized clinical trial. Ann Surg 269:596–602

    Article  Google Scholar 

  3. Bertucci Zoccali M, Biondi A, Krane M, Kueberuwa E, Rizzo G, Persiani R, Coco C, Hurst RD, D'Ugo D, Fichera A (2015) Risk factors for wound complications in patients undergoing primary closure of the perineal defect after total proctectomy. Int J Colorectal Dis 30:87–95

    Article  Google Scholar 

  4. Boelens PG, Heesakkers FF, Luyer MD, van Barneveld KW, de Hingh IH, Nieuwenhuijzen GA, Roos AN, Rutten HJ (2014) Reduction of postoperative ileus by early enteral nutrition in patients undergoing major rectal surgery: prospective, randomized, controlled trial. Ann Surg 259:649–655

    Article  Google Scholar 

  5. Bertrand K, Lefevre JH, Creavin B, Luong M, Debove C, Voron T, Chafai N, Tiret E, Parc Y (2019) The management of perineal hernia following abdomino-perineal excision for cancer. Hernia. https://doi.org/10.1007/s10029-019-01927-7

    Article  PubMed  Google Scholar 

  6. Peirce C, Martin S (2016) Management of the perineal defect after abdominoperineal excision. Clin Colon Rectal Surg 29:160–167

    Article  Google Scholar 

  7. de Campos FG, Habr-Gama A, Araujo SE, Sousa AH Jr, Nahas CR, Lupinacci RM, Nahas SC, Kiss DR, Gama-Rodrigues J (2005) Incidence and management of perineal hernia after laparoscopic proctectomy. Surg Laparosc Endosc Percutaneous Tech 15:366–370

    Article  Google Scholar 

  8. Wang YW, Huang LY, Song CL, Zhuo CH, Shi DB, Cai GX, Xu Y, Cai SJ, Li XX (2015) Laparoscopic vs open abdominoperineal resection in the multimodality management of low rectal cancers. World J Gastroenterol 21:10174–10183

    Article  CAS  Google Scholar 

  9. Foster JD, Tou S, Curtis NJ, Smart NJ, Acheson A, Maxwell-Armstrong C, Watts A, Singh B, Francis NK (2018) Closure of the perineal defect after abdominoperineal excision for rectal adenocarcinoma—ACPGBI position statement. Colorectal Dis 20(Suppl 5):5–23

    Article  Google Scholar 

  10. Foster JD, Gash KJ, Carter FJ, West NP, Acheson AG, Horgan AF, Longman RJ, Coleman MG, Moran BJ, Francis NK (2014) Development and evaluation of a cadaveric training curriculum for low rectal cancer surgery in the English LOREC national development programme. Colorectal Dis 16:O308–319

    Article  CAS  Google Scholar 

  11. Mathis KL, Larson DW, Dozois EJ, Cima RR, Huebner M, Haddock MG, Wolff BG, Nelson H, Pemberton JH (2012) Outcomes following surgery without radiotherapy for rectal cancer. Br J Surg 99:137–143

    Article  CAS  Google Scholar 

  12. Blok RD, Musters GD, Borstlap WAA, Buskens CJ, Bemelman WA, Tanis PJ, Collaborative Dutch Snapshot Research Group (2018) Snapshot study on the value of omentoplasty in abdominoperineal resection with primary perineal closure for rectal cancer. Ann Surg Oncol 25:729–736

    Article  Google Scholar 

  13. Tooley JE, Sceats LA, Bohl DD, Read B, Kin C (2018) Frequency and timing of short-term complications following abdominoperineal resection. J Surg Res 231:69–76

    Article  Google Scholar 

  14. Woodfield J, Hulme-Moir M, Ly J (2017) A comparison of the cost of primary closure or rectus abdominis myocutaneous flap closure of the perineum after abdominoperineal excision. Colorectal Dis 19:934–941

    Article  CAS  Google Scholar 

  15. Yasukawa D, Hori T, Kadokawa Y, Kato S, Aisu Y, Hasegawa S (2018) Trans-perineal minimally invasive surgery during laparoscopic abdominoperineal resection for low rectal cancer. Surg Endosc 32:437

    Google Scholar 

  16. Musters GD, Buskens CJ, Bemelman WA, Tanis PJ (2014) Perineal wound healing after abdominoperineal resection for rectal cancer: a systematic review and meta-analysis. Dis Colon Rectum 57:1129–1139

    Article  Google Scholar 

  17. Melich G, Lim DR, Hur H, Min BS, Baik SH, Arena GO, Gordon PH, Kim NK (2016) Prevention of perineal hernia after laparoscopic and robotic abdominoperineal resection: review with illustrative case series of internal hernia through pelvic mesh. Can J Surg 59:54–58

    Article  Google Scholar 

  18. Warembourg S, Labaki M, de Tayrac R, Costa P, Fatton B (2017) Reoperations for mesh-related complications after pelvic organ prolapse repair: 8-year experience at a tertiary referral center. Int Urogynecol J 28:1139–1151

    Article  Google Scholar 

  19. Killeen S, Mannion M, Devaney A, Winter DC (2013) Omentoplasty to assist perineal defect closure following laparoscopic abdominoperineal resection. Colorectal Dis 15:e623–626

    Article  CAS  Google Scholar 

  20. Killeen S, Devaney A, Mannion M, Martin ST, Winter DC (2013) Omental pedicle flaps following proctectomy: a systematic review. Colorectal Dis 15:e634–645

    Article  CAS  Google Scholar 

  21. Feng B, Lu J, Zhang S, Yan X, Li J, Xue P, Wang M, Lu A, Ma J, Zang L, Dong F, He Z, Yue F, Sun J, Hong X, Zheng M (2017) Laparoscopic abdominoperineal excision with trans-abdominal individualized levator transection: interim analysis of a randomized controlled trial. Colorectal Dis 19:O246–O252

    Article  CAS  Google Scholar 

  22. Foster JD, Pathak S, Smart NJ, Branagan G, Longman RJ, Thomas MG, Francis N (2012) Reconstruction of the perineum following extralevator abdominoperineal excision for carcinoma of the lower rectum: a systematic review. Colorectal Dis 14:1052–1059

    Article  CAS  Google Scholar 

  23. Martijnse IS, Holman F, Nieuwenhuijzen GA, Rutten HJ, Nienhuijs SW (2012) Perineal hernia repair after abdominoperineal rectal excision. Dis Colon Rectum 55:90–95

    Article  CAS  Google Scholar 

  24. Balla A, Batista Rodriguez G, Buonomo N, Martinez C, Hernandez P, Bollo J, Targarona EM (2017) Perineal hernia repair after abdominoperineal excision or extralevator abdominoperineal excision: a systematic review of the literature. Tech Coloproctol 21:329–336

    Article  CAS  Google Scholar 

  25. Teramura K, Watanabe Y, Takeuchi S, Nakamura F, Hirano S (2018) Laparoscopic repair with cone-shaped mesh implantation for perineal hernia occurred after laparoscopic abdominoperineal resection. Int J Surg Case Rep 49:115–117

    Article  Google Scholar 

  26. Mjoli M, Sloothaak DA, Buskens CJ, Bemelman WA, Tanis PJ (2012) Perineal hernia repair after abdominoperineal resection: a pooled analysis. Colorectal Dis 14:e400–406

    Article  CAS  Google Scholar 

  27. Sayers AE, Patel RK, Hunter IA (2015) Perineal hernia formation following extralevator abdominoperineal excision. Colorectal Dis 17:351–355

    Article  CAS  Google Scholar 

  28. Yang T, Wei M, Deng X, Meng W, Wang Z (2019) A Novel laparoscopic technique with a bladder peritoneum flap closure for pelvic cavity for patients with rigid pelvic peritoneum after neoadjuvant radiotherapy in laparoscopic extralevator abdominoperineal excision. Dis Colon Rectum 62:5

    Article  Google Scholar 

Download references

Funding

This work was supported by Shanghai Municipal Commission of Health and Family Planning Program (201640030), Shanghai translational medicine collaborative innovation center program (TM201701), Shanghai Shen-kang Hospital Development Centre (16CR1011A).

Author information

Author notes

  1. Xialin Yan and Hao Su contributed equally to this work.

Authors and Affiliations

  1. Department of General Surgery, Shanghai Minimally Invasive Surgery Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No. 197, Ruijin Er Road, Shanghai, 200025, China

    Xialin Yan, Hao Su, Sen Zhang, Leqi Zhou, Jiaoyang Lu, Xiao Yang, Jianwen Li, Pei Xue, Zirui He, Mingliang Wang, Aiguo Lu, Junjun Ma, Lu Zang, Zhenghao Cai, Jing Sun, Hiju Hong, Minhua Zheng & Bo Feng

  2. Department of Gastrointestinal Surgery, Shanghai Tenth People’s Hospital, School of Medicine, Tongji University, Shanghai, China

    Xialin Yan

Authors
  1. Xialin Yan
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Hao Su
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Sen Zhang
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Leqi Zhou
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Jiaoyang Lu
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Xiao Yang
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Jianwen Li
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Pei Xue
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Zirui He
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Mingliang Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Aiguo Lu
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Junjun Ma
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Lu Zang
    View author publications

    You can also search for this author in PubMed Google Scholar

  14. Zhenghao Cai
    View author publications

    You can also search for this author in PubMed Google Scholar

  15. Jing Sun
    View author publications

    You can also search for this author in PubMed Google Scholar

  16. Hiju Hong
    View author publications

    You can also search for this author in PubMed Google Scholar

  17. Minhua Zheng
    View author publications

    You can also search for this author in PubMed Google Scholar

  18. Bo Feng
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding authors

Correspondence to Minhua Zheng or Bo Feng.

Ethics declarations

Diclosures

Xialin Yan, Hao Su, Sen Zhang, Leqi Zhou, Jiaoyang Lu, Xiao Yang, Jianwen Li, Pei Xue, Zirui He, Mingliang Wang, Aiguo Lu, Junjun Ma, Lu Zang, Cai Zhenghao, Jing Sun, Hiju Hong, Minhua Zheng, and Bo Feng have no conflicts of interest or financial ties to disclose.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Yan, X., Su, H., Zhang, S. et al. Pelvic peritoneum closure reduces postoperative complications of laparoscopic abdominoperineal resection: 6-year experience in single center. Surg Endosc 35, 406–414 (2021). https://doi.org/10.1007/s00464-020-07414-w

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-020-07414-w

Keywords

Search

Navigation