PASSIVE VS CLOSED SUCTION DRAINAGE AFTER PERINEAL WOUND CLOSURE FOLLOWING ABDOMINOPERINEAL RECTAL EXCISION FOR CARCINOMA - A MULTICENTER, CONTROLLED TRIAL

PURPOSE: Because evacuation of effusion or collection could depend on the type of drainage, we compared the effects of closed suction draina ge with passive drainage through tubes or undulated drains after abdom inoperineal rectal excision for carcinoma on early and late perineal w ound healing. METHODS: Of 234 consecutive patients undergoing abdomino perineal rectal excision for carcinoma between January 1983 and August 1990, unsatisfactory hemostasis or gross intraoperative septic contam ination were recorded in 48 patients who were not included in the tria l. After rectal excision and closure of the perineum, the remaining 18 6 patients were randomized to receive passive drainage (PD; n = 96) or closed suction drainage (SD; n = 90). Eighteen patients were withdraw n because of protocol violation, and three were lost to follow-up, lea ving 165 (89 PD and 76 SD) patients for analysis. Preoperative factors (sex, age, degree of obesity, weight loss, anemia, or presence of asc ites), intraoperative and pathologic findings (Dukes stage), and posto perative courses (recurrence, late mortality) were similar in both gro ups. All patients were followed up for 12 months or until death. RESUL TS: The rate of perineums healed at one month was significantly lower (P < 0.05) in PD (55/89 = 61 percent) compared with SD (54/72 = 75 per cent) patients. At three months, the rate of healed perineums no longe r differed between the two groups (70/87 = 81 percent v s. 60/72 = 84 percent). The number of vaginal fistulas, secondary reopenings, and pe rineums not healed at 12 months was similar in both groups. Median dur ation to complete healing was similar in both groups (23 vs. 21 days, respectively). On the other hand, three retained drains were seen in P D patients only. The median duration of hospital stay was identical in both groups (22 days). Seven patients died in the early postoperative period, including one in the PD group and six in the SD group. There was no significant difference in the number of late deaths (3 vs. 7) i n PD and SD patients, respectively. CONCLUSION: These results suggest that closed suction drainage should be used after abdominoperineal rec tal excision with satisfactory hemostasis or absence of grass intraope rative septic contamination.