Continent perineal colostomy after abdominoperineal resection - Outcome after 63 cases

PURPOSE: For patients with distal rectal or anal tumors, quality of life can be compromised after abdominoperineal resection and iliac colostomy. This study examines our experience with a continent perineal colostomy constructed from a colonic smooth-muscle cuff wrap. METHODS: Between 1987 and 1996, 63 patients with distal rectal or anal tumors (0-5 cm from the anal verge) underwent abdominoperineal resection and construction of a colonic smooth-muscle cuff at the site of the perineal colostomy. Postoperatively, all patients required colonic irrigations daily or every two days. The complications, continence at 6 and 12 months, and degree of satisfaction were prospectively evaluated using a standard questionnaire. RESULTS: Early complications included partial perineal dehiscence in 14 (22.5 percent) patients,pelvic abscess in 2 (3 percent) patients, and colostomy necrosis in 1 (1.6 percent) patient. Late complications were colostomy stricture in 7 (11.8 percent) patients, perineal sinus tract in 4 (6.7 percent) patients, and mucosal prolapse in 12 (20 percent) patients. Satisfactory continence (complete continence to stool and incontinence to gas) at 6 and 12 months was achieved in 30 (55.6 percent) and 27 (59 percent) patients, respectively. Patient satisfaction was noted in 85 percent. CONCLUSION: Continent perineal colostomy can serve as an alternative to conventional iliac colostomy. Most patients were satisfied. The modest complication rate can be minimized with patient selection.