Perineal morbidity and functional results of pseudocontinent perineal colostomy for low rectal cancer surgery: Retrospective study of 149 cases.

Abstract

e14133 Background: This retrospective study was designed to evaluate morbidity and functional results of pseudocontinent perineal colostomy (PCPC) using Schmidt’s technique in North African patients undergoing APR for managing low rectal adenocarcinoma. Methods: During 15 years, 380 Abdominoperineal resections for low rectal cancer were performed. One hundred forty nine cases among them had PCPC. There were 76 women, with an average age of 47 years old. All patients received néoadjuvante radiotherapy with or without chemotherapy. Functional results were evaluated prospectively at regular intervals. Results: There was no postoperative mortality. Operative Morbidity rate was only 18.3%, essentially dominated by perineal suppuration (40%). According to Kirwan score on a Functional level, 95 patients had gaz incontinence and 46 patients an occasional minimal soiling. At one year surveillance, the graft was clinically well detected in 72% of cases and anorectal manometric study on 15 cases showed a hypotonic pseudosphincter. Colic irrigation rhythm was, in 74% of cases, every 24 to 48h, and 15% of patients didn’t need irrigations any more 6 months after surgery. Except for major postoperative complications, no other conversion from perineal colostomy to an iliac colostomy was performed for dissatisfactory functional results since 77% of the patients were satisfied and 23% half-way satisfied of this technique. Conclusions: Pseudocontinent perineal colostomy is a simple, safe and reliable technique that represents an interesting alternative to permanent iliac colostomy after APR for low rectal adenocarcinoma. It improves perineal healing and provides good functional results and high degree of patient satisfaction in addition to body image preservation. it is well adapted to north-african cultural economical and religious coditions.