| Popis: |
Management of the pelvic space after rectal excision is still problematic. Two methods have to be preferred: (1) closed suction lavage drainage and (2) open wound plugging; then the pelvic floor best remains unsutured. Plugging is always indicated in difficult pelveoperitoneal suture, unsatisfactory hemostasis and fecal contamination of the pelvic space. Retardation of wound healing is compensated for by more comfort for the patient and elimination of late complications, compared with those with partially closed or secondary opened wounds. The sacroperineal scar is the origin of a lot of complaints and morbidity. The most important are: infectious complications and persistent fistula (17.3%), pseudosinus perinealis (10%), perineal hernia and genital prolapses (16%), urologic complications (recidivating infections [26.9%], changes of the position of the urinary bladder [56%], secondary retroperitoneal fibrosis with urinary restriction [19.2%] or hydronephrosis [3.8%], disturbances of bladder emptying [36.5%], frequently combined with neurogenic lesions because of intraoperatively dissected autonomous pelvic nerves), local recurrence of carcinoma (17.3% in reexamination, but still much more important), and pain, often of unknown origin (34%). |
