Seromuscular spiral cuff perineal colostomy: an alternative to abdominal wall colostomy after abdominoperineal excision for rectal cancer.

Seromuscular spiral cuff perineal colostomy may be an alternative to abdominal wall colostomy after abdomino-perineal excision. We present our initial experience with the procedure in 13 patients operated upon between March 1993 and December 1997. Patients undergoing abdomino-perineal excision for rectal cancer, under 65 years of age, without severe concomitant disease, and strongly motivated to comply with an intensive postoperative physiotherapy were selected. The neosphincter procedure comprised a pull-through of a sufficient length of well-vascularized colon, 12 cm of which was then cleared of fat. In this segment, the seromuscular layer was separated from the mucosa, cut into a longitudinal sheet and wrapped in spirals around the colon at its perineal insertion. One patient died from pulmonary embolism. A second patient suffered from ischemic necrosis of the distal colon and lost his neosphincter. Minor complications included one stenosis, corrected by surgery, and one iatrogenic lesion on rectoscopy at another institution. No patients experienced local recurrence, while four patients presented distant metastases. Initially, all patients suffered from incontinence. After 6 months, 6 of 11 evaluable patients showed total and 5 showed partial continence.