[Cross suture closure technique of the perineal wound following abdominoperineal resection].

OBJECTIVE: The aim of this study is to introduce a new type of cross suture in closing peritoneal incision after abdominoperineal resection (APR) for rectal cancer.

METHODS: This new type of cross suture was firstly proposed and applied in a small cohort in our hospital. In this study, we reported its efficacy and safety. From Feb 2018 to May 2018, 8 cases (5 male, 3 female) of rectal cancer from the Sixth Affiliated Hospital of Sun Yat-Sen University receiving APR with new cross suture, were analyzed retrospectively. The median age was 45.5 years and the median distance between tumor distant border and anal verge was 2.5 cm. Three patients received neoadjuvant therapy. The detailed procedures of new cross suture are listed as follows: (1)Marking the margin: an oval circle around the anus is designed. The anterior incision reaches middle peritoneum, and the posterior incision is close to the coccyx apex. Two triangle incisions are made at the 3 and 9 point directions of lithotomy position, respectively. (2)Tumor resection: purse string suture is made to close the anus, then cut open the peritoneal skin and fatty tissue according to the principles of total mesorectal resection(TME). Reserve the fatty tissue in the ischiorectal space as much as possible. R0 resection is required. Approximate the pelvic muscles and fatty tissue in the ischiorectal space to reduce residual cavity; (3)Close the peritoneal incision by absorbable stitch: Two intracutaneous stiches in the anterior and posterior parts of the incision are made. Then four intracutaneous circle stiches along the two triangles are performed. The incision appears like a "cross" after tighting these stiches. A drainage was placed in presacral space.

RESULTS: All procedures were successfully conducted in 8 cases and no severe complication occurred after surgery. The median volume of whole surgery bleeding was 100 ml and the median time of the peritoneal surgery was 50 minutes. The median volume of drainage was 95 ml in the first 3 postoperative days. The median time of drainage removal was 5 days. Seven cases received primary wound healing without superficial(wound infection and dehiscence) or deep perineal wound(perineal abscess and presacral abscess) complications. Presacral abscess occurred in one case. The median time of primary wound healing was 11 days.

CONCLUSION: The new cross suture for perineal incision after APR procedure is simple with satisfying efficacy. The drainage of residue cavity in the presacral space is complete. The cross suture reduces the time of primary wound healing and decreases scars.