tailieunhanh - Improved Outcomes in Colon and Rectal Surgery part 30

Improved Outcomes in Colon and Rectal Surgery part 30. Written by many of the worlds leading colorectal surgeons, this evidence-based text investigates the risks and benefits of colorectal surgeries. By using clinical pathways, algorithms, and case discussions, the authors identify the best practices for patient safety and positive outcomes to ensure that physicians correctly recognize potential problems and carefully manage complications | 2J Abdominoperineal resection W Brian Perry Fia Yi Clarence Clark and Danny Kim CHALLENGING CASE A 64-year-old woman is 7 days s p an abdominopernneal resection for a T2N1 rectal adenocarcinoma. She had received preoperative. Her perineal wound has developed increased tenderness is swollen and is draining pus. CASE MANAGEMENT The patient s wound is opened and the patient is started on three times a day dressing changes. After 2 days the wound is clean and a vacuum assisted closure VAC dressing is placed. INTRODUCTION Abdominoperineal resection APR completely removes the distal colon rectum and anal sphincter complex using both anterior abdominal and perineal incisions resulting in a permanent colostomy. Developed more than 100 years ago it remains an important tool in the treatment of rectal cancer despite advances in sphincter-sparing procedures. We will examine a brief history of this procedure current operative techniques and complications expected results both oncologic and with regard to quality of life and what the future may hold for this procedure. Several recent reports have noted the increase in the use of sphincter-sparing options for patients diagnosed with rectal cancer. Abraham and colleagues found a 10 decrease in the rate of APR from 1989 to 2001 as compared with low anterior resection LAR using national administrative data. 1 When controlled for several variables including patient demographics and hospital volume patients were 28 more likely to have an LAR later in the study period. Schoetz notes that LAR outnumbers APR three to one in the submitted case logs of recent colorectal fellows. 2 This ratio is similar to that found in the Swedish rectal cancer registry where approximately 25 of over 12 000 patients with rectal cancer underwent APR from 1995-2002. 3 In no study or registry however has APR been eliminated. HISTORY Early in the twentieth century most patients with rectal cancer underwent perineal procedures to address typically .