Excision and Primary Closure

Wide excision and primary closure with removal of all fibrous tracks can be a very difficult procedure to carry out, especially in high presacral tracks. Quite often the wound cannot be sutured directly, and resulting the dead space is likely to become infected. As a matter of fact, Scammel and Keighley [24], in a group of 17 patients with Crohn's disease, obtained primary closure in three cases only. Neoadjuvant RT increases the risk of perineal wound complications after APR [25]. Bullard et al. [26] have recently reported the results of primary perineal closure after APR in a series of 117 patients who received neoadjuvant radiotherapy to downstage rectal cancer and decrease the risk of local recurrence. Major perineal wound complications were reported in 35%. Delayed healing was the most common complication with a mean healing time of 3.8±2.7 months (range 1-12). Five patients developed a PPS: four in the RT group, one in the control group. The authors concluded that in patients undergoing neoadjuvant radiotherapy, primary closure of the perineum should not be considered the option of choice.

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