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

Abstract

Zhongbo Han, Chunxia Yang, Qingfeng Wang, Meng Wang, Xi Li, Chao Zhang Department of Gastrointestinal Surgery, Zibo Central Hospital, Shandong University, Zibo, Shandong, People’s Republic of ChinaCorrespondence: Chao ZhangDepartment of Gastrointestinal Surgery, Zibo Central Hospital, Shandong University, 54 West Gongqingtuan Road, Zibo, Shandong, 255000, People’s Republic of ChinaTel [phone]Fax [phone]Email [email protected]: 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.Keywords: low rectal cancer, extralevator abdominoperineal excision, negative pressure drainage, surgical site infection

Keywords

• low rectal cancer
• extralevator abdominoperineal excision
• negative pressure drainage
• surgical site infection