MANAGEMENT OF THE PELVIC SPACE WITH OR WITHOUT OMENTOPLASTY AFTER ABDOMINOPERINEAL RESECTION FOR CARCINOMA OF THE RECTUM - A PROSPECTIVE MULTICENTER STUDY

Objective: To compare perineal healing with or without omentoplasty af ter abdominoperineal resection for carcinoma of the rectum. Design: Pr ospective multicentre study. Setting: 15 centres (three university, ni ne non-university teaching hospitals and three private clinics), Franc e. Subjects: 186 consecutive patients (between January 1983 and August 1990): 21 were withdrawn because of protocol violation leaving 165 fo r analysis. Interventions: Abdominoperineal resection for adenocarcino ma of the distal third of the rectum followed by omentoplasty (n = 64) to the pelvic space or not (n = 101). Main outcome measures: Number o f healed perineums at one month, and the time interval to complete hea ling. Results: 7 patients (4%) died, 4 of whom had had omentoplasty an d 3 who had not (one perineal abscess). The number who developed immed iate postoperative complications (11/64, 17% and 18/101, 18%) and medi an duration of hospital stay (21 days, range 8-191, and 22 days, range 8-132) were similar. The median time to complete healing (20 and 21 d ays), the rate of healed perineums at one month (42/62 and 67/99, both 68%) and the number of persisting sinuses at 12 months were also simi lar. The number of dehiscences of the perineum was significantly highe r (p = 0.04) in the no omentoplasty group (16 compared with 3). There were 3 late deaths in the omentoplasty group and 7 in the no omentopla sty group, 1 and 5 with local recurrence, respectively. There were mor e recurrences in the no omentoplasty group but not significantly so. C onclusions: Although this study was not randomised, the results sugges t that omentoplasty to the pelvic space promotes perineal healing afte r abdominoperineal resection for carcinoma of the rectum by significan tly reducing the need for secondary opening.