Wennström B1,2*, Henriksson G2, Johansen L2, Hassel K2 and Skullman S2
1Department of Anaesthesia, Skaraborg Hospital, Sweden
2Department of Surgery, Skaraborg Hospital, Sweden
Objective: Infections and wound healing problems after abdominoperineal resection of the rectum (APR) are common. In 2013, a retrospective review of consecutive APRs in 2010-2012 was performed at Skaraborg Hospital, Skövde, Sweden. The review showed that 66 % (27 out of 41) of the patients, who were operated on in the prone jack-knife position, had a perineal infection and wound healing problems. Because of these alarming results, we scrutinized every step of the perioperative care process and created a nine-step concept. The aim of this study was to determine whether the introduction of this intervention had resulted in a decrease in postoperative perineal infections and the length of perineal wound healing in patients undergoing APR.Methods: A prospective study during 2013-2014 included 41 consecutive patients who had undergone APR. The diagnoses were rectal cancer (n=36), Crohn’s disease (n=2), ulcerative colitis (n=2), and familiar polyposis (n=1). A comparison was made with the consecutive historical controls from 2010-2012. Time to wound healing was recorded and the severity of the infection was classified according to a modified Clavien Classification of Surgical Complications. Clinical data were collected from the Swedish ColoRectal Cancer Registry.Results: After the introduction of the nine-step concept the infection rate was reduced from 66 % to 10 % (p< 0.001).Conclusion: The nine-step concept significantly reduced the perineal infections after APR. Fewer infections mean less suffering for the patient and substantially reduced use of health care resources.
Perineal infections; Abdominoperineal; Anaesthesia
Wennstrom B, Henriksson G, Johansen L, Hassel K, Skullman S. A Successful Nine-Step Concept to Reduce the Risk of Perineal Infections after Abdominoperineal Resection of the Rectum. Clin Surg. 2016; 1: 1172.