Perineal wound closure after abdomino-perineal excision of the rectum.

Wound infections have a significant impact on the postoperative morbidity after abdomino-perineal rectum resection (APR). However, the technique of perineal wound closure after APR has not been standardised yet. The prospective German multicentre trial "Colorectal Carcinoma (primary tumor)" (study I) enrolled 10 335 patients with rectal cancer over a time period from 1 January 2000 to 31 December 2002. The APR rate was 24.7% (n=2517). Four hundred and forty-five patients (17.6%) developed an infectious complication of the perineal incision. In contrast, the data of the reporting single centre participating in study I were as follows: patients with rectal cancer, n=206; APR, n=37; APR rate, n=18.0% (study II). In our surgical department, a standardised technique of perineal wound closure comprising tight sutures of the tissue in three layers (muscle, ischiorectal and subcutaneous fat), local administration of carriers releasing antibiotics and a redon drainage were used. Using these tools, the rate of septic perineal wound complications was considerably lower with 5.4% vs. 17.6% in the multicentre trial.