The role of perineal application of prophylactic negative-pressure wound therapy for prevention of wound-related complic
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REVIEW
The role of perineal application of prophylactic negative-pressure wound therapy for prevention of wound-related complications after abdomino-perineal resection: a systematic review Jeremy Meyer 1
&
Elin Roos 2 & Ziad Abbassi 1 & Christian Toso 1 & Frédéric Ris 1 & Nicolas C. Buchs 1
Accepted: 25 August 2020 # The Author(s) 2020
Abstract Background Closed perineal wounds often fail to heal by primary intention after abdomino-perineal resection (APR) and are often complicated by surgical site infection (SSI) and/or wound dehiscence. Recent evidence showed encouraging results of prophylactic negative-pressure wound therapy (pNPWT) for prevention of wound-related complications in surgery. Our objective was to gather and discuss the early existing literature regarding the use of pNPWT to prevent wound-related complications on perineal wounds after APR. Methods Medline, Embase, and Web of Science were searched for original publications and congress abstracts reporting the use of pNPWT after APR on closed perineal wounds. Results Seven publications were included for analysis. Two publications reported significantly lower incidence of SSI in pNPWT patients than in controls with a risk reduction of about 25–30%. Two other publications described similar incidences of SSI between the two groups of patients but described SSI in pNPWT patients to be less severe. One study reported significantly lower incidence of wound dehiscence in pNPWT patients than in controls. Conclusion The largest non-randomized studies investigating the effect of pNPWT on the prevention of wound-related complications after APR showed encouraging results in terms of reduction of SSI and wound dehiscence that deserve further investigation and confirmation. Keywords Abdomino-perineal amputation . Abdomino-perineal resection . Colorectal cancer . Rectal cancer . Infection . Perineal infection
Introduction Abdomino-perineal resection (APR) of the rectum consists of the ablation of the terminal colon, the rectum, the internal and external sphincters, and the confection of a terminal colostomy, as initially described by Miles [1]. APR is usually indicated for Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00384-020-03732-6) contains supplementary material, which is available to authorized users. * Jeremy Meyer [email protected] 1
Division of Digestive Surgery, University Hospitals of Geneva, Rue Gabrielle-Perret-Gentil 4, 1211 Genève 14, Switzerland
2
Department of Global Public Health, Karolinska Institute, Stockholm, Sweden
advanced adenocarcinomas of the lower third of the rectum (within 5 cm from the anal verge) and for recurrent squamous cell carcinoma of the rectum or anal margin after chemo-radiotherapy. Improvements to the techniques include neoadjuvant radio-chemotherapy for stages T 3–4 and/or radiologically node-positive adenocarcinomas, synchronous abdominal and perineal approaches, total mesorectum excision (TME, as introduced by Heald [2]), and minimally invasive techniques avo
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