PERINEAL WOUND MANAGEMENT AFTER ABDOMINOPERINEAL RECTAL EXCISION FOR CARCINOMA WITH UNSATISFACTORY HEMOSTASIS OR GROSS SEPTIC CONTAMINATION- PRIMARY CLOSURE VS PACKING - A MULTICENTER, CONTROLLED TRIAL

PURPOSE: This study was designed to compare the results of two methods on the rate of postoperative perineum healing. PATIENTS AND METHODS: In this prospective, randomized, multicenter trial of 234 consecutive patients undergoing abdominoperineal rectal excision for carcinoma, 48 had unsatisfactory hemostasis or intraoperative gross septic contamin ation. Three patients were withdrawn because of protocol violation. Of the 45 remaining patients, 21 were randomized to undergo primary clos ure of the perineum with drainage while 24 underwent packing. Preopera tive factors (sex, age, degree of obesity, weight loss, anemia, or pre sence of ascites), intraopera tive findings (Dukes stage, degree of he mostasis, gross septic contamination), and postoperative oncologic cou rses (recurrence, mortality rate) were similar in both groups. All pat ients were followed for at least 12 months or until their demise. RESU LTS: There was no significant difference in the number of early (one v s. zero) or late (five vs. four) deaths between primary closure and pa cking groups, respectively. Median duration of hospital stay was 25 an d 27 days, respectively. Primary closure was associated with a signifi cantly higher rate of healed perineums at one month (30 percent vs. 0 percent) (P = 0.01) and a shorter delay to complete cicatrization (med ian, 47 vs. 69 days) (P < 0.01). From three months onward, there was n o difference in healing between the two groups, but two patients in th e packing group had not healed at one year. Conversely, hematoma, peri neal abscess, and reoperations were significantly more frequent (P < 0 .01) in the primary closure group. CONCLUSION: Primary closure associa ted with drainage after abdominoperineal resection for carcinoma exped ites perineal healing but morbidity is higher.