PURPOSE: For patients with distal rectal or anal tumors, quality of life ca
n be compromised after abdominoperineal resection and iliac colostomy. This
study examines our experience with a continent perineal colostomy construc
ted from a colonic smooth-muscle cuff wrap. METHODS: Between 1987 and 1996,
63 patients with distal rectal or anal tumors (0-5 cm from the anal verge)
underwent abdominoperineal resection and construction of a colonic smooth-
muscle cuff at the site of the perineal colostomy. Postoperatively, all pat
ients required colonic irrigations daily or every two days. The complicatio
ns, continence at 6 and 12 months, and degree of satisfaction were prospect
ively evaluated using a standard questionnaire. RESULTS: Early complication
s included partial perineal dehiscence in 14 (22.5 percent) patients,pelvic
abscess in 2 (3 percent) patients, and colostomy necrosis in 1 (1.6 percen
t) patient. Late complications were colostomy stricture in 7 (11.8 percent)
patients, perineal sinus tract in 4 (6.7 percent) patients, and mucosal pr
olapse in 12 (20 percent) patients. Satisfactory continence (complete conti
nence to stool and incontinence to gas) at 6 and 12 months was achieved in
30 (55.6 percent) and 27 (59 percent) patients, respectively. Patient satis
faction was noted in 85 percent. CONCLUSION: Continent perineal colostomy c
an serve as an alternative to conventional iliac colostomy. Most patients w
ere satisfied. The modest complication rate can be minimized with patient s
election.