ABSTRACT
OBJECTIVES: This study aimed to determine if abdominal sacral colpopexy (ASC) using mesh can be safely combined with sigmoid resection and anastomosis. METHODS: This is a single institution, retrospective chart review of patients who underwent combined ASC and suture rectopexy with sigmoid resection between January 1, 2007, and December 31, 2011. Charts were screened for outcome data and complications related to the placement of synthetic mesh at the time of bowel resection to include readmission and reoperation rates, infection, bowel obstruction, fistula, and mesh erosion. Outcome data for patients receiving combined procedures were compared to 2 separate cohorts of patients as follows: a group that underwent only ASC with polypropylene mesh and a group that underwent only sigmoid resection plus or minus suture rectopexy. The DINDO surgical classification system was used for each cohort to further analyze complications. RESULTS: There were 133 patients in the ASC only group (ASC only), 34 in the combined ASC and sigmoid resection group (Combined), and 27 in the sigmoidectomy plus rectopexy group (Colorectal only). The Colorectal only cohort had a higher rate of postoperative ileus; ASC only 3.8%, Combined 5.9%, Colorectal 22.2% (P = 0.004). There were otherwise no differences in intraoperative and postoperative complications or in the DINDO classification scores. CONCLUSIONS: Abdominal sacral colpopexy with placement of synthetic mesh at the time of sigmoid resection and anastomosis does not seem to increase the rate of intraoperative or postoperative complications.
Subject(s)
Colectomy/adverse effects , Gynecologic Surgical Procedures/adverse effects , Pelvic Organ Prolapse/surgery , Colon, Sigmoid/surgery , Constipation/etiology , Female , Humans , Ileus/etiology , Middle Aged , Retrospective Studies , Sacrum/surgery , Surgical Mesh/adverse effects , Suture Techniques , Vagina/surgeryABSTRACT
The neoplasms of the anus discussed in this article are uncommon, and therefore lack a consistent diagnostic and treatment algorithm derived from prospective clinical trial datasets. There may be an opportunity to design prospective Phase II clinical trials, with established uniform surgical pathology, surgical technique guidelines, and endpoints. The American College of Surgeons Oncology Group may have an opportunity to design and carry out controlled clinical trials for select rare anal neoplasms. Such an effort may yield modern benchmarks with which to base subsequent patient care algorithms.
