The role of perineal application of prophylactic negative-pressure wound therapy for prevention of wound-related complications after abdomino-perineal resection: a systematic review

Meyer, Jérémy; Röös, Elin; Abbassi, Ziad; Toso, Christian; Ris, Frédéric; Buchs, Nicolas

doi:10.1007/s00384-020-03732-6

Cited by 13 publications

(8 citation statements)

References 17 publications

(16 reference statements)

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“…27,28 A few meta-analyses have confirmed that the use of negative pressure wound therapy could reduce the risk of SSI and other wound-related complications after APR. 17,19,29 Negative pressure suction with irrigation has been reported to be an efficient technique for the management of deep SSI. 30 Therefore, negative pressure drainage with irrigation is becoming a main trend in the prevention and treatment of complicated deep SSI.…”

Section: Discussionmentioning

confidence: 99%

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Continuous Negative Pressure Drainage with Intermittent Irrigation Leaded to a Risk Reduction of Perineal Surgical Site Infection Following Laparoscopic Extralevator Abdominoperineal Excision for Low Rectal Cancer

Han

Yang

Wang

et al. 2021

TCRM

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Purpose High rate of perineal surgical site infection (SSI) is the most common complication following abdominoperineal resection (APR), especially for extralevator abdominoperineal excision (ELAPE). The purpose of this study was to investigate the effect of continuous negative pressure drainage combined with intermittent irrigation (CNPDCII) in the presacral space on the perineal SSI following laparoscopic ELAPE for low rectal cancer. Patients and Methods The clinical data of 99 patients with low rectal cancer who underwent laparoscopic ELAPE surgery were retrospectively analyzed. Among the 99 patients, 46 patients received CNPDCII and 53 patients received conventional drainage in the presacral space after ELAPE. Self-made irrigation drainage tube: took a silicone drainage tube, cut 3 side holes at every 2cm intervals at the front end, and fixed a flexible tube of an intravenous needle at the front end of the silicone drainage tube. The conventional drainage tube or self-made irrigation drainage tube was placed in the presacral space and poked out from the inside of the ischial tuberosity. The incidence of SSI and other perioperative indicators between the two groups was compared within 30 days after surgery. Results There was no statistical difference in clinicopathological features between the two groups of patients (p>0.05). A statistically lower rate of SSI was found in CNPDCII group (17.4%, 8/46) than the conventional drainage group (35.8%, 19/53). The drainage tube retention time (7.8±1.2 d VS 9.4±1.6 d) and the postoperative hospital stay (9.7±1.4 d VS 11.9±2.3 d) in CNPDCII group were significantly shortened than the conventional drainage group. There was no statistical difference in operating theatre time and intraoperative blood loss between the two groups. Multivariate analysis confirmed that CNPDCII was an independent protective factor for SSI after ELAPE. Conclusion CNPDCII can effectively reduce the incidence of SSI following laparoscopic ELAPE, which is simple, safe and effective.

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Section: Discussionmentioning

confidence: 99%

“…18 Recently, the use of prophylactic negative-pressure wound therapy for prevention of wound-related complications showed encouraging results in terms of reduction of SSI after APR. 19 But this continuous negative pressure device was set on the incision surface. Therefore, it played a minor role in deep or presacral space infection.…”

Section: Introductionmentioning

confidence: 99%

Continuous Negative Pressure Drainage with Intermittent Irrigation Leaded to a Risk Reduction of Perineal Surgical Site Infection Following Laparoscopic Extralevator Abdominoperineal Excision for Low Rectal Cancer

Han

Yang

Wang

et al. 2021

TCRM

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“…When the wound fails to heal, a conventional negative pressure wound therapy (NPWT) device can be considered. In a recent systematic review, the use of NPWT represents an encouraging tool in reducing surgical site infection and wound dehiscence in these patients [35]. Once the perineum is sutured, pneumoperitoneum is reinduced.…”

Section: Surgical Steps Of Miles' Operationmentioning

confidence: 99%

Robotic Rectal Resection for Rectal Cancer: State of the Art

Stefano¹,

Intini²,

Costantini³

et al. 2022

Recent Understanding of Colorectal Cancer Treatment

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Surgical resection with total mesorectal excision (TME) represents a crucial milestone in the treatment of rectal cancer. Conventional open procedures have been gradually replaced by minimally invasive techniques. To date, laparoscopic and robotic resection associated with neoadjuvant chemo-radiotherapy, represent the gold standard for rectal malignancies. Robotic surgery, when performed by an experienced surgeon, can offer advantages in case of difficult anatomical conditions, such as in male patients with a narrow pelvis. Higher costs remain a matter of debate in the diffusion of robotic platforms in general surgery. However, encouraging surgical outcomes and a shorter learning curve for the surgeon counterbalance the associated expense. Different surgical approaches are available for rectal cancer, according to the extension of the tumor and its location. The cornerstone of the different approaches is represented by TME, both transabdominally and transanally. Adequate TME, associated with neoadjuvant therapy, is pivotal in the success of the oncological treatment, in terms of curative results and reduced recurrence. Current different approaches are low anterior resection, abdominoperineal resection, and intersphincteric resection. They can all be performed with the robotic system and their surgical steps are described in this chapter.

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“…Both studies found that the perineal hernia rate was significantly lower in biologic mesh reconstruction as compared to primary closure and the operation time and hospital stay were shorter after primary perineal closure [ 125 , 126 ]. Other studies have shown a lower incidence of surgical site infection using prophylactic negative-pressure wound therapy to prevent wound-related complications in surgery, with a risk reduction of about 25% to 30% [ 127 ].…”

Section: Surgical Managementmentioning

confidence: 99%

Surgical Treatment of Low-Lying Rectal Cancer: Updates

Varela

Kim

2021

Ann Coloproctol

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Despite innovative advancements, distally located rectal cancer remains a critical disease of challenging management. The crucial location of the tumor predisposes it to a circumferential resection margin (CRM) that tends to involve the anal sphincter complex and surrounding organs, with a high incidence of delayed anastomotic complications and the risk of the pelvic sidewall or rarely inguinal lymph node metastases. In this regard, colorectal surgeons should be aware of other issues beyond total mesorectal excision (TME) performance. For decades, the concept of extralevator abdominoperineal resection to avoid compromised CRM has been introduced. However, the complexity of deep pelvic dissection with poor visualization in low-lying rectal cancer has led to transanal TME. In contrast, neoadjuvant chemoradiotherapy (NCRT) has allowed for the execution of more sphincter-saving procedures without oncologic compromise. Significant tumor regression after NCRT and complete pathologic response also permit applying the watch-and-wait protocol in some cases, now with more solid evidence. This review article will introduce the current surgical treatment options, their indication and technical details, and recent oncologic and functional outcomes. Lastly, the novel characteristics of distal rectal cancer, such as pelvic sidewall and inguinal lymph node metastases, will be discussed along with its tailored and individualized treatment approach.

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The role of perineal application of prophylactic negative-pressure wound therapy for prevention of wound-related complications after abdomino-perineal resection: a systematic review

Cited by 13 publications

References 17 publications

Continuous Negative Pressure Drainage with Intermittent Irrigation Leaded to a Risk Reduction of Perineal Surgical Site Infection Following Laparoscopic Extralevator Abdominoperineal Excision for Low Rectal Cancer

Continuous Negative Pressure Drainage with Intermittent Irrigation Leaded to a Risk Reduction of Perineal Surgical Site Infection Following Laparoscopic Extralevator Abdominoperineal Excision for Low Rectal Cancer

Robotic Rectal Resection for Rectal Cancer: State of the Art

Surgical Treatment of Low-Lying Rectal Cancer: Updates

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