Experience in surgical correction of genital prolapse caused by abdominoperineal operations for colon cancer in anamnesis

In recent studies, it has been established that extralevator abdominoperineal extirpation (ELAPE) of the rectum can improve the oncological results of treatment of distal rectal cancer compared to standard abdominoperineal extirpation. As a result of extralevator dissection, a large defect of the perineum is formed, which requires plastic closure. While performing ELAPE, the structures that form the pelvic diaphragm are affected. This increases the risk of pelvic organ prolapse in women and significantly affects the quality of life of these patients, which requires subsequent surgical treatment. Despite the fact that pelvic organ prolapse develops as a consequence of previous surgical treatment by an oncologist, they do not consider it as a complication in the long-term postoperative period. Such patients are not referred to the operating gynecologist. Currently, this problem is poorly understood and there are no standardized approaches to the surgical treatment of pelvic prolapse in this category of patients.

Prevention of paracolostomal complications following abdominoperineal extirpation of the rectum

Aim. To find an optimal way of end colostoma formation in patients with colorectal cancer following abdominoperineal extirpation of the rectum. Methods. Results of surgical treatment (rectum extirpation ended with sigmoidostomy) of 142 patients with malignant tumors of lower part of rectal ampulla treated from 2005 to 2012 are presented. Data of 101 patients (comparison group) were retrospectively analyzed, in whom the same approach of choosing the colostomy technique was applied. The main group consisted of 41 patients in whom the efficacy of authors-introduced technique of colostomy with alloplasty for colostomal wound consolidation from the abdominal cavity side was prospectively defined. Results. The prevalence of early post-operative stomal complications was 18,8% (in 19 out of 109 patients) in comparison group. Ileum volvulus around the stoma causing bowel obstruction was diagnosed in 2 cases, necrosis of stoma wall - in 2 patients, evisceration around stoma site - in 3 patients, perforation of sigmoid stoma - in 1 patient, stoma retraction - in 1 patient, bleeding at stoma site - in 3 patients, paracolostomal mass - in 1 patient. 14 patients from comparison group developed late post-operative stomal complications, including parastomal hernia - 8 patients, stoma prolapse - 3 patients, colostomal fistula - 1 patient, stomal stenosis - 2 patients. Treatment results in the patients from the main group were satisfactory. Early complications included 1 case of bleeding from stoma site, 1 case of partial necrosis of stoma wall. No late complications were registered. The gained data allows to provide successful rehabilitation to patients who underwent colorectal cancer surgery. The described technique is contraindicated in case of infected peritoneal effusion. Conclusion. The use of the method proposed by authors not only significantly improves colostomy results, but significantly decreases the rate of both early and late post-operative complications of stomas compared to standard methods.