DOI: 10.4103/jcrt.jcrt_133_26 ISSN: 1998-4138

Pelvic peritoneal apposition following abdominoperineal resection: A 10-year longitudinal observational cohort study from a Government Hospital in Eastern India

Suvendu Maji, Ria Ganguly, Vikram Chaturvedi, Jayesh Kumar Jha
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ABSTRACT

Background:

Pelvic peritoneal apposition (closure) following abdominoperineal resection (APR) for rectal cancer remains controversial. While some surgeons advocate peritoneal closure to prevent adhesions, others recommend leaving the pelvis open to avoid tension-related complications. This observational cohort study compared early postoperative outcomes between these two surgical approaches.

Methods:

This 10-year retrospective cohort study included 54 patients undergoing APR (open or laparoscopic) between January 2010 and January 2020 at Medical College, Kolkata. Patients were stratified into two groups: peritoneum apposed ( n = 29) versus peritoneum left open ( n = 25). Follow-up ranged from 2 to 10 years. Primary outcome was early postoperative small bowel obstruction (EPSBO); secondary outcomes included postoperative infection, length of hospitalization, and disease stage.

Results:

EPSBO occurred in 10 patients (18.5%), with 9/10 in the apposed group and 1/10 in the open group (odds ratio [OR] 10.8, 95% confidence interval [CI] 1.22–95.4, P = 0.030). Postoperative infection was significantly more common in the apposed group (11/29, 37.9%) than in the open group (3/25, 12.0%; OR 4.48, 95% CI 1.08–18.5, P = 0.038). Peritoneal apposition was more frequently performed in patients >50 years of age ( P = 0.044). Only one patient required surgical exploration for acute obstruction; the remaining nine recovered with conservative management.

Conclusion:

In this cohort, leaving the pelvic peritoneum open after APR was associated with significantly lower rates of EPSBO and postoperative infection compared to peritoneal apposition.

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