ABDOMINOPERINEAL RESECTION AND PERINEAL COLOSTOMY FOR LOW RECTAL-CANCER - THE DASILVA,LAZARO TECHNIQUE

PURPOSE: We sought to evaluate a new technique for creation of a conti nent perineal colostomy following abdominoperineal resection (APR) of the rectum for low rectal cancer. METHODS: Nine selected patients with low rectal cancer (two males; median age, 55.6 years; classified as D ukes A, 6 patients and as Dukes B, 3 patients) underwent APR. Followin g this, the original Lazaro da Silva technique was used as follows: 1) for performance of three circular myotomies in the distal sigmoid wit h a distance between each couple of no more than 8 cm; 2) repair of th e myotomies, thus creating three circular colonic valves, the most dis tal of which remained extraperitoneally; 3) for construction of a peri neal colostomy lying flush with the perineal skin; 4) after the patien t starts consuming a regular diet, enemas through the perineal stoma a re done, usually twice per week, to achieve defecation. Functional out come was assessed by evaluation of bowel movements and neoanal contine nce. RESULTS: There were no deaths. From January 1994 until October 19 95, no tumor recurrence has occurred, and fecal continence has been go od. Four of the patients were able to defecate without enemas (2-4 tim es per week), and in five patients the self-administration of enemas ( 2-4 times a week) were necessary to accomplish defecation. CONCLUSION: Initial results with the Lazaro da Silva technique have been encourag ing.