Prone positioning reduces perineal infections when performing the miles procedure

Abstract

BackgroundAbdominoperineal resection (APR) remains the cornerstone treatment for rectal cancers less than 5 cm from the anal verge. The perineal portion of an APR can be done with the patient in lithotomy or repositioned to prone jack-knife position, which influences accessibility, visualization and ability to close the wound. This paper analyses the effect of patient positioning on perineal wound dehiscence and infections. MethodsA retrospective review of all rectal cancer patients who underwent an APR at Massachusetts General Hospital between 2004 and 2014 (n = 149). Patients were divided into supine (n = 91) or prone (n = 58) positioning as documented in operative reports. ResultsTwenty-two percent of supine positioned patients developed a perineal wound infection, versus 3.4% of the prone patients (P = 0.002). Perineal wound dehiscence rate was also higher in the supine positioned group (14.3% vs. prone 3.4%; P = 0.032). Multivariable analysis showed OR = 9.2 of developing a perineal wound infection for supine positioned patients, compared to prone, corrected for obesity and smoking history. ConclusionRepositioning patients into prone position for the perineal portion of an APR was associated with significantly lower perineal wound infection and dehiscence rates compared to supine positioned patients.