Background
Wound infection is one of the most common complications following abdominoperineal resection. In some studies, it was assumed that it can reach up to 66% among the operated patients. It not only affects the pathway of wound healing but can also delay the beginning of postoperative chemotherapy. It may also leave lifelong adverse consequences such as pain, sitting disability, and tingling.
Patients and methods
A prospective randomized controlled study was performed on 52 patients who were eligible for abdominoperineal resection for either low rectal or anal canal carcinoma admitted to Helwan University Hospital, Nasser Institute Hospital, and 15th May Hospital between January 2018 and January 2022. Inclusion criteria were both male and female participants in the ages of 18 and 80 years who were diagnosed with low rectal or anal canal cancers. Exclusion criteria were patients who had inoperable, multicentric, recurring anorectal cancers. All of the patients were informed about the details of the study and the procedure preoperatively and signed an informed written consent. The same team of surgeons operated all the cases, and the classic operation of resecting the rectum with complete mesorectal excision was done through the classic abdominal route. Based on the steps for preparation of the perineal phase of the abdominoperineal resection, participants were allocated randomly into two groups. Group A included 27 patients in whom the anal closure was done first after primary skin cleansing and then final skin cleansing and draping was done. Group B included 25 patients in whom anal closure was done after final skin cleansing and draping.
Results
Group A included 27 (51.9%) patients who had their anal closure done before the final draping, and group B included 25 (48.1%) patients who had their anal closure done after the final draping. Their mean±SD age was 54.3±9.69 years (55 and 53.5 years for groups A and B, respectively). Their preoperative comorbidities included diabetes mellitus in 20 (38.5%) patients, with 12 (44%) and eight (32%) in groups A and B, respectively; hypertension in 18 (34.6%) patients; and chronic heart diseases in six (11.5%) patients. Their BMI was ∼27.87±3.2 kg/m. Surgical site infection (SSI) was statistically significantly lower in group A in comparison with group B (11.1 and 36%, respectively; value 0.03). We further divided the incisional SSI into superficial and deep. Deep SSI was not found in any cases among group A, whereas it was observed in three (12%) cases in group B. Moreover, superficial SSI was found in only three (11.1%) cases in group A, whereas it was observed in six (24%) cases in group B.
Conclusion
Anal closure performed before perineal draping decreased field contamination and subsequent SSI and healing time.