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Clin Colon Rectal Surg 2009; 22(1): 051-059
DOI: 10.1055/s-0029-1202887
© Thieme Medical Publishers

Complications of Perineal Surgery

James W. Ogilvie1 , Rocco Ricciardi2 , 3
  • 1Department of Surgery, University of Minnesota Medical School, Minneapolis, Minnesota
  • 2Department of Colon and Rectal Surgery, Lahey Clinic, Burlington, Massachusetts
  • 3Department of Surgery, Tufts University School of Medicine, Boston, Massachusetts
Further Information

Publication History

Publication Date:
09 March 2009 (online)

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ABSTRACT

Anorectal procedures are associated with significant morbidity and include complications of the perineum, which can cause substantial difficulty for the patient. Prevention of perineal complications is key, but many anorectal procedures are performed in difficult situations such as large bulky tumors or inflammatory bowel diseases. In this review, the authors outline many of the complications encountered following both simple and complex anorectal procedures while highlighting best evidence for treatment.

KEYWORDS

Perineal complication - anorectal surgery - morbidity

REFERENCES

  • 1 Christian C K, Kwaan M R, Betensky R A, Breen E M, Zinner M J, Bleday R. Risk factors for perineal wound complications following abdominoperineal resection.  Dis Colon Rectum. 2005;  48(1) 43-48
    CrossrefPubMedGoogle Scholar
  • 2 Manjoney D L, Koplewitz M J, Abrams J S. Factors influencing perineal wound healing after proctectomy.  Am J Surg. 1983;  145(1) 183-189
    CrossrefPubMedGoogle Scholar
  • 3 Bullard K M, Trudel J L, Baxter N N, Rothenberger D A. Primary perineal wound closure after preoperative radiotherapy and abdominoperineal resection has a high incidence of wound failure.  Dis Colon Rectum. 2005;  48(3) 438-443
    CrossrefPubMedGoogle Scholar
  • 4 Chadwick M A, Vieten D, Pettitt E, Dixon A R, Roe A M. Short course preoperative radiotherapy is the single most important risk factor for perineal wound complications after abdominoperineal excision of the rectum.  Colorectal Dis. 2006;  8(9) 756-761
    CrossrefPubMedGoogle Scholar
  • 5 Frye J N, Carne P W, Robertson G M, Frizelle F A. Abdominoperineal resection or low Hartmann's procedure.  ANZ J Surg. 2004;  74(7) 537-540
    CrossrefPubMedGoogle Scholar
  • 6 Murrell Z A, Dixon M R, Vargas H, Arnell T D, Kumar R, Stamos M J. Contemporary indications for and early outcomes of abdominoperineal resection.  Am Surg. 2005;  71(10) 837-840
    PubMedGoogle Scholar
  • 7 Ferrari B T, DenBesten L. The prevention and treatment of the persistent perineal sinus.  World J Surg. 1980;  4(2) 167-172
    CrossrefPubMedGoogle Scholar
  • 8 Tompkins R G, Warshaw A L. Improved management of the perineal wound after proctectomy.  Ann Surg. 1985;  202(6) 760-765
    CrossrefPubMedGoogle Scholar
  • 9 Farid H, O'Connell T X. Methods to decrease the morbidity of abdominoperineal resection.  Am Surg. 1995;  61(12) 1061-1064
    PubMedGoogle Scholar
  • 10 Scheidbach H, Schneider C, Konradt J et al.. Laparoscopic abdominoperineal resection and anterior resection with curative intent for carcinoma of the rectum.  Surg Endosc. 2002;  16(1) 7-13
    CrossrefPubMedGoogle Scholar
  • 11 Chessin D B, Enker W, Cohen A M et al.. Complications after preoperative combined modality therapy and radical resection of locally advanced rectal cancer: a 14-year experience from a specialty service.  J Am Coll Surg. 2005;  200(6) 876-882 discussion 882-874
    CrossrefPubMedGoogle Scholar
  • 12 Wu J S, Birnbaum E H, Fleshman J W. Early experience with laparoscopic abdominoperineal resection.  Surg Endosc. 1997;  11(5) 449-455
    CrossrefPubMedGoogle Scholar
  • 13 Corman M L, Veidenheimer M C, Coller J A, Ross V H. Perineal wound healing after proctectomy for inflammatory bowel disease.  Dis Colon Rectum. 1978;  21(3) 155-159
    CrossrefPubMedGoogle Scholar
  • 14 Scammell B E, Keighley M R. Delayed perineal wound healing after proctectomy for Crohn's colitis.  Br J Surg. 1986;  73(2) 150-152
    CrossrefPubMedGoogle Scholar
  • 15 Artioukh D Y, Smith R A, Gokul K. Risk factors for impaired healing of the perineal wound after abdominoperineal resection of rectum for carcinoma.  Colorectal Dis. 2007;  9(4) 362-367
    CrossrefPubMedGoogle Scholar
  • 16 Oakley J R, Fazio V W, Jagelman D G, Lavery I C, Weakley F L, Easley K. Management of the perineal wound after rectal excision for ulcerative colitis.  Dis Colon Rectum. 1985;  28(12) 885-888
    CrossrefPubMedGoogle Scholar
  • 17 Waits J O, Dozois R R, Kelly K A. Primary closure and continuous irrigation of the perineal wound after proctectomy.  Mayo Clin Proc. 1982;  57(3) 185-188
    PubMedGoogle Scholar
  • 18 Jalan K N, Smith A N, Ruckley C V, Falconer C W, Small W P, Prescott R J. Perineal wound healing in ulcerative colitis.  Br J Surg. 1969;  56(10) 749-753
    PubMedGoogle Scholar
  • 19 Williams J Z, Barbul A. Nutrition and wound healing.  Surg Clin North Am. 2003;  83(3) 571-596
    CrossrefPubMedGoogle Scholar
  • 20 Hulten L, Kewenter J, Knutsson U, Olbe L. Primary closure of perineal wound after proctocolectomy or rectal excision.  Acta Chir Scand. 1971;  137(5) 467-469
    PubMedGoogle Scholar
  • 21 Broader J H, Masselink B A, Oates G D, Alexander-Williams J. Management of the pelvic space after proctectomy.  Br J Surg. 1974;  61(2) 94-97
    PubMedGoogle Scholar
  • 22 Irvin T T, Goligher J C. A controlled clinical trial of three different methods of perineal wound management following excision of the rectum.  Br J Surg. 1975;  62(4) 287-291
    CrossrefPubMedGoogle Scholar
  • 23 Baudot P, Keighley M R, Alexander-Williams J. Perineal wound healing after proctectomy for carcinoma and inflammatory disease.  Br J Surg. 1980;  67(4) 275-276
    PubMedGoogle Scholar
  • 24 Nilsson P J, Svensson C, Goldman S, Glimelius B. Salvage abdominoperineal resection in anal epidermoid cancer.  Br J Surg. 2002;  89(11) 1425-1429
    CrossrefPubMedGoogle Scholar
  • 25 Bai Y K, Cao W L, Gao J D, Liang J, Shao Y F. Surgical salvage therapy of anal cancer.  World J Gastroenterol. 2004;  10(3) 424-426
    PubMedGoogle Scholar
  • 26 Ferenschild F T, Vermaas M, Hofer S O, Verhoef C, Eggermont A M, de Wilt J H. Salvage abdominoperineal resection and perineal wound healing in local recurrent or persistent anal cancer.  World J Surg. 2005;  29(11) 1452-1457
    CrossrefPubMedGoogle Scholar
  • 27 Papaconstantinou H T, Bullard K M, Rothenberger D A, Madoff R D. Salvage abdominoperineal resection after failed Nigro protocol: modest success, major morbidity.  Colorectal Dis. 2006;  8(2) 124-129
    CrossrefPubMedGoogle Scholar
  • 28 Shibata D, Hyland W, Busse P et al.. Immediate reconstruction of the perineal wound with gracilis muscle flaps following abdominoperineal resection and intraoperative radiation therapy for recurrent carcinoma of the rectum.  Ann Surg Oncol. 1999;  6(1) 33-37
    CrossrefPubMedGoogle Scholar
  • 29 Tei T M, Stolzenburg T, Buntzen S, Laurberg S, Kjeldsen H. Use of transpelvic rectus abdominis musculocutaneous flap for anal cancer salvage surgery.  Br J Surg. 2003;  90(5) 575-580
    CrossrefPubMedGoogle Scholar
  • 30 Nissan A, Guillem J G, Paty P B et al.. Abdominoperineal resection for rectal cancer at a specialty center.  Dis Colon Rectum. 2001;  44(1) 27-35 discussion 35-26
    CrossrefPubMedGoogle Scholar
  • 31 Randomized study on preoperative radiotherapy in rectal carcinoma. Stockholm Colorectal Cancer Study Group.  Ann Surg Oncol. 1996;  3(5) 423-430 [No authors listed]
    CrossrefPubMedGoogle Scholar
  • 32 Initial report from a Swedish multicentre study examining the role of preoperative irradiation in the treatment of patients with resectable rectal carcinoma. Swedish Rectal Cancer Trial.  Br J Surg. 1993;  80(10) 1333-1336 [No authors listed]
    CrossrefPubMedGoogle Scholar
  • 33 Marijnen C A, Kapiteijn E, van de Velde C J et al.. Acute side effects and complications after short-term preoperative radiotherapy combined with total mesorectal excision in primary rectal cancer: report of a multicenter randomized trial.  J Clin Oncol. 2002;  20(3) 817-825
    CrossrefPubMedGoogle Scholar
  • 34 Horn A, Halvorsen J F, Dahl O. Preoperative radiotherapy in operable rectal cancer.  Dis Colon Rectum. 1990;  33(10) 823-828
    PubMedGoogle Scholar
  • 35 Randomised trial of surgery alone versus radiotherapy followed by surgery for potentially operable locally advanced rectal cancer. Medical Research Council Rectal Cancer Working Party.  Lancet. 1996;  348(9042) 1605-1610 [No authors listed]
    CrossrefPubMedGoogle Scholar
  • 36 Luna-Perez P, Rodriguez-Ramirez S, Vega J, Sandoval E, Labastida S. Morbidity and mortality following abdominoperineal resection for low rectal adenocarcinoma.  Rev Invest Clin. 2001;  53(5) 388-395
    PubMedGoogle Scholar
  • 37 Valero G, Lujan J A, Hernandez Q et al.. Neoadjuvant radiation and chemotherapy in rectal cancer does not increase postoperative complications.  Int J Colorectal Dis. 2003;  18(6) 495-499
    CrossrefPubMedGoogle Scholar
  • 38 Hyams D M, Mamounas E P, Petrelli N et al.. A clinical trial to evaluate the worth of preoperative multimodality therapy in patients with operable carcinoma of the rectum: a progress report of National Surgical Breast and Bowel Project Protocol R-03.  Dis Colon Rectum. 1997;  40(2) 131-139
    PubMedGoogle Scholar
  • 39 Sauer R, Becker H, Hohenberger W et al.. Preoperative versus postoperative chemoradiotherapy for rectal cancer.  N Engl J Med. 2004;  351(17) 1731-1740
    CrossrefPubMedGoogle Scholar
  • 40 Bujko K, Nowacki M P, Kepka L, Oledzki J, Bebenek M, Kryj M. Postoperative complications in patients irradiated pre-operatively for rectal cancer: report of a randomised trial comparing short-term radiotherapy vs chemoradiation.  Colorectal Dis. 2005;  7(4) 410-416
    CrossrefPubMedGoogle Scholar
  • 41 Mannaerts G H, Rutten H J, Martijn H, Groen G J, Hanssens P E, Wiggers T. Abdominosacral resection for primary irresectable and locally recurrent rectal cancer.  Dis Colon Rectum. 2001;  44(6) 806-814
    PubMedGoogle Scholar
  • 42 Kim H K, Jessup J M, Beard C J et al.. Locally advanced rectal carcinoma: pelvic control and morbidity following preoperative radiation therapy, resection, and intraoperative radiation therapy.  Int J Radiat Oncol Biol Phys. 1997;  38(4) 777-783
    CrossrefPubMedGoogle Scholar
  • 43 Nuyttens J J, Kolkman-Deurloo I K, Vermaas M et al.. High-dose-rate intraoperative radiotherapy for close or positive margins in patients with locally advanced or recurrent rectal cancer.  Int J Radiat Oncol Biol Phys. 2004;  58(1) 106-112
    CrossrefPubMedGoogle Scholar
  • 44 Hashiguchi Y, Sekine T, Sakamoto H et al.. Intraoperative irradiation after surgery for locally recurrent rectal cancer.  Dis Colon Rectum. 1999;  42(7) 886-893 discussion 893-885
    PubMedGoogle Scholar
  • 45 Lindel K, Willett C G, Shellito P C et al.. Intraoperative radiation therapy for locally advanced recurrent rectal or rectosigmoid cancer.  Radiother Oncol. 2001;  58(1) 83-87
    CrossrefPubMedGoogle Scholar
  • 46 Bosset J F, Collette L, Calais G et al.. Chemotherapy with preoperative radiotherapy in rectal cancer.  N Engl J Med. 2006;  355(11) 1114-1123
    CrossrefPubMedGoogle Scholar
  • 47 Ley E J, Vukasin P, Kaiser A M, Ault G, Beart Jr R W. Delayed rectovaginal fistula: a potential complication of bevacizumab (Avastin).  Dis Colon Rectum. 2007;  50(6) 930
    CrossrefPubMedGoogle Scholar
  • 48 Adenis A, Vanseymortier L, Foissey D, Colombel J F. Bevacizumab and postponed suture leakages after surgery for ulcerative colitis and rectal cancer.  Gut. 2007;  56(5) 734
    CrossrefPubMedGoogle Scholar
  • 49 August D A, Serrano D, Poplin E. “Spontaneous,” delayed colon and rectal anastomotic complications associated with bevacizumab therapy.  J Surg Oncol. 2008;  97(2) 180-185
    CrossrefPubMedGoogle Scholar
  • 50 Altemeier W A, Culbertson W R, Alexander J W, Sutorius D, Bossert J. Primary closure and healing of the perineal wound in abdominoperineal resection of the rectum for carcinoma.  Am J Surg. 1974;  127(2) 215-219
    CrossrefPubMedGoogle Scholar
  • 51 Fingerhut A, Hay J M, Delalande J P, Paquet J C. Passive vs. closed suction drainage after perineal wound closure following abdominoperineal rectal excision for carcinoma. A multicenter, controlled trial. The French Association for Surgical Research.  Dis Colon Rectum. 1995;  38(9) 926-932
    CrossrefPubMedGoogle Scholar
  • 52 Rothenberger D A, Wong W D. Abdominoperineal resection for adenocarcinoma of the low rectum.  World J Surg. 1992;  16(3) 478-485
    CrossrefPubMedGoogle Scholar
  • 53 Leicester R J, Ritchie J K, Wadsworth J, Thomson J P, Hawley P R. Sexual function and perineal wound healing after intersphincteric excision of the rectum for inflammatory bowel disease.  Dis Colon Rectum. 1984;  27(4) 244-248
    CrossrefPubMedGoogle Scholar
  • 54 Dencker H, Norryd C, Tranberg K G. Management of the perineal wound after rectal excision.  Acta Chir Scand. 1973;  139(6) 568-570
    PubMedGoogle Scholar
  • 55 Robles Campos R, Garcia Ayllon J, Parrila Paricio P et al.. Management of the perineal wound following abdominoperineal resection: prospective study of three methods.  Br J Surg. 1992;  79(1) 29-31
    PubMedGoogle Scholar
  • 56 Hartz R S, Poticha S M, Shields T W. Healing of the perineal wound.  Arch Surg. 1980;  115(4) 471-474
    PubMedGoogle Scholar
  • 57 Pahlman L, Enblad P, Stahle E. Abdominal vs. perineal drainage in rectal surgery.  Dis Colon Rectum. 1987;  30(5) 372-375
    CrossrefPubMedGoogle Scholar
  • 58 Wilkening H, Bodeker H, Gebhardt C. Wound healing of the pelvis following abdominoperineal rectum extirpation. A comparison of 2 drainage procedures in a prospective randomized study.  Chirurg. 1988;  59(1) 20-23
    PubMedGoogle Scholar
  • 59 Dougherty S H, Simmons R L. The biology and practice of surgical drains. Part II.  Curr Probl Surg. 1992;  29(9) 633-730
    PubMedGoogle Scholar
  • 60 Galandiuk S, Fazio V W. Postoperative irrigation-suction drainage after pelvic colonic surgery. A prospective randomized trial.  Dis Colon Rectum. 1991;  34(3) 223-228
    PubMedGoogle Scholar
  • 61 McLeod R, Cohen Z, Langer B, Taylor B. Primary perineal wound closure following excision of the rectum.  Can J Surg. 1983;  26(2) 122-124
    PubMedGoogle Scholar
  • 62 Delalande J P, Hay J M, Fingerhut A, Kohlmann G, Paquet J C. Perineal wound management after abdominoperineal rectal excision for carcinoma with unsatisfactory hemostasis or gross septic contamination: primary closure vs. packing. A multicenter, controlled trial. French Association for Surgical Research.  Dis Colon Rectum. 1994;  37(9) 890-896
    CrossrefPubMedGoogle Scholar
  • 63 Del Pino A, Abcarian H. The difficult perineal wound.  Surg Clin North Am. 1997;  77(1) 155-174
    CrossrefPubMedGoogle Scholar
  • 64 Eftaiha M, Abcarian H. Management of perineal wounds after proctocolectomy: a retrospective study of 50 cases in which treatment by the open technique was used.  Dis Colon Rectum. 1978;  21(4) 287-291
    PubMedGoogle Scholar
  • 65 Mazier W P, Surrell J A, Senagore A J. The bottom end. Handling of the perineal wound after abdominoperineal resection.  Am Surg. 1991;  57(7) 454-458
    PubMedGoogle Scholar
  • 66 Khoo A K, Skibber J M, Nabawi A S et al.. Indications for immediate tissue transfer for soft tissue reconstruction in visceral pelvic surgery.  Surgery. 2001;  130(3) 463-469
    CrossrefPubMedGoogle Scholar
  • 67 Kapoor V, Cole J, Isik F F, Sinanan M, Flum D. Does the use of a flap during abdominoperineal resection decrease pelvic wound morbidity?.  Am Surg. 2005;  71(2) 117-122
    PubMedGoogle Scholar
  • 68 Radice E, Nelson H, Mercill S, Farouk R, Petty P, Gunderson L. Primary myocutaneous flap closure following resection of locally advanced pelvic malignancies.  Br J Surg. 1999;  86(3) 349-354
    CrossrefPubMedGoogle Scholar
  • 69 De Broux E, Parc Y, Rondelli F, Dehni N, Tiret E, Parc R. Sutured perineal omentoplasty after abdominoperineal resection for adenocarcinoma of the lower rectum.  Dis Colon Rectum. 2005;  48(3) 476-481 discussion 481-472
    CrossrefPubMedGoogle Scholar
  • 70 Nilsson P J. Omentoplasty in abdominoperineal resection: a review of the literature using a systematic approach.  Dis Colon Rectum. 2006;  49(9) 1354-1361
    CrossrefPubMedGoogle Scholar
  • 71 Bratzler D W, Houck P M. Antimicrobial prophylaxis for surgery: an advisory statement from the National Surgical Infection Prevention Project.  Clin Infect Dis. 2004;  38(12) 1706-1715
    CrossrefPubMedGoogle Scholar
  • 72 Meyer L, Bereuter M, Marusch F et al.. Perineal wound closure after abdomino-perineal excision of the rectum.  Tech Coloproctol. 2004;  8(suppl 1) s230-s234
    CrossrefPubMedGoogle Scholar
  • 73 Gruessner U, Clemens M, Pahlplatz P V, Sperling P, Witte J, Rosen H R. Improvement of perineal wound healing by local administration of gentamicin-impregnated collagen fleeces after abdominoperineal excision of rectal cancer.  Am J Surg. 2001;  182(5) 502-509
    CrossrefPubMedGoogle Scholar
  • 74 Bascom T, Bascom J U. Persistent perineal sinus after proctectomy for Crohn's disease; simplified repair using skin flap.  Am J Surg. 2002;  184(1) 85 , author reply 85
    PubMedGoogle Scholar
  • 75 Branagan G, Thompson M R, Senapati A. Cleft closure for the treatment of unhealed perineal sinus.  Colorectal Dis. 2006;  8(4) 314-317
    CrossrefPubMedGoogle Scholar
  • 76 Silen W, Glotzer D J. The prevention and treatment of the persistent perineal sinus.  Surgery. 1974;  75(4) 535-542
    PubMedGoogle Scholar
  • 77 Pemberton J H. How to treat the persistent perineal sinus after rectal excision.  Colorectal Dis. 2003;  5(5) 486-489
    CrossrefPubMedGoogle Scholar
  • 78 Yousaf M, Witherow A, Gardiner K R, Gilliland R. Use of vacuum-assisted closure for healing of a persistent perineal sinus following panproctocolectomy: report of a case.  Dis Colon Rectum. 2004;  47(8) 1403-1407 discussion 1407-1408
    PubMedGoogle Scholar
  • 79 Hyman N H. Unhealed perineal wound. In: Fazio VW, Church JM, Delaney CP Current Therapy in Colon and Rectal Surgery. Philadelphia; Elsevier Mosby 2005: 241-243
    Google Scholar
  • 80 Hull T L, Milsom J W, Church J et al.. Electrogalvanic stimulation for levator syndrome: how effective is it in the long term?.  Dis Colon Rectum. 1993;  36 731-733
    CrossrefPubMedGoogle Scholar
  • 81 Joo I S, Agachan F, Wolff B et al.. Initial North American experience with botulinum toxin type A for treatment of anismus.  Dis Colon Rectum. 1996;  39 1107-1111
    CrossrefPubMedGoogle Scholar
  • 82 So J B, Palmer M T, Shellito P C. Postoperative perineal hernia.  Dis Colon Rectum. 1997;  40 954-957
    CrossrefPubMedGoogle Scholar
  • 83 Aboian E, Winter D C, Metcalf D R, Wolff B G. Perineal hernia after proctectomy: prevalence, risks, and management.  Dis Colon Rectum. 2006;  49(10) 1564-1568
    CrossrefPubMedGoogle Scholar
  • 84 Skipworth R JE, Smith G HM, Anderson D N. Secondary perineal hernia following open abdominoperineal excision of the rectum: report of a case and review of the literature.  Hernia. 2007;  11 541-545
    CrossrefPubMedGoogle Scholar
  • 85 Sarr M G, Stewart J R, Cameron J C. Combined abdominoperineal approach to repair of postoperative perineal hernia.  Dis Colon Rectum. 1982;  25(6) 597-599
    CrossrefPubMedGoogle Scholar
  • 86 Beck D E, Fazio V W, Jagelman D G, Lavery I C, McGonagle B A. Postoperative perineal hernia.  Dis Colon Rectum. 1987;  30(1) 21-24
    PubMedGoogle Scholar
  • 87 So J B, Palmer M T, Shellito P C. Postoperative perineal hernia.  Dis Colon Rectum. 1997;  40(8) 954-957
    CrossrefPubMedGoogle Scholar
  • 88 Hull T L. Recurrent postoperative perineal hernia: transperineal redo mesh repair.  Dis Colon Rectum. 2007;  50 1080-1081
    CrossrefPubMedGoogle Scholar
  • 89 Leroi A M, Kamm M A, Weber J, Denis P, Hawley P R. Internal anal sphincter repair.  Int J Colorectal Dis. 1997;  12 243-245
    CrossrefPubMedGoogle Scholar
  • 90 Wolff B G. The Whitehead hemorrhoidectomy. An unjustly maligned procedure.  Dis Colon Rectum. 1988;  31 587-590
    CrossrefPubMedGoogle Scholar
  • 91 Ferguson J A. Whitehead deformity of anus, S-plasty repair.  Dis Colon Rectum. 1979;  22 286-287
    CrossrefPubMedGoogle Scholar
  • 92 Koh P K, Tang C L, Eu K W, Samuel M, Chan E. A systematic review of the function and complications of colonic pouches.  Int J Colorectal Dis. 2007;  22 543-548
    CrossrefPubMedGoogle Scholar
  • 93 Christensen M A, Pitsch R M, Cali R I, Blatchford G J, Thorson A G. House advancement pedicle flap for anal stenosis.  Dis Colon Rectum. 1992;  35 201-203
    CrossrefPubMedGoogle Scholar
  • 94 Pidala M J, Slezak F A, Porter J A. Island flap anoplasty for anal canal stenosis and mucosal ectropion.  Am Surg. 1994;  3 194-196
    PubMedGoogle Scholar
  • 95 Bleday R, Pena J P, Rothenberger D A, Goldberg S M, Buls J G. Symptomatic hemorrhoids: current incidence and complications of operative therapy.  Dis Colon Rectum. 1992;  35 477-481
    CrossrefPubMedGoogle Scholar
  • 96 Berry A R, de Campos R, Lee E C. Perineal and pelvic morbidity following perimuscular excision of the rectum for inflammatory bowel disease.  Br J Surg. 1986;  73(8) 675-677
    PubMedGoogle Scholar
  • 97 Changchien C R, Yeh C Y, Huang S T, Hsieh M L, Chen J S, Tang R. Postoperative urinary retention after primary colorectal cancer resection via laparotomy: a prospective study of 2,355 consecutive patients.  Dis Colon Rectum. 2007;  50(10) 1688-1696
    CrossrefPubMedGoogle Scholar
  • 98 Maurer C A, Z'Graggen K, Renzulli P, Schilling M K, Netzer P, Buchler M W. Total mesorectal excision preserves male genital function compared with conventional rectal cancer surgery.  Br J Surg. 2001;  88(11) 1501-1505
    PubMedGoogle Scholar
  • 99 Mundy A R. An anatomical explanation for bladder dysfunction following rectal and uterine surgery.  Br J Urol. 1982;  54(5) 501-504
    PubMedGoogle Scholar
  • 100 Gerstenberg T C, Nielsen M L, Clausen S, Blaabjerg J, Lindenberg J. Bladder function after abdominoperineal resection of the rectum for anorectal cancer. Urodynamic investigation before and after operative in a consecutive series.  Ann Surg. 1980;  191(1) 81-86
    PubMedGoogle Scholar
  • 101 Michelassi F, Block G E. Morbidity and mortality of wide pelvic lymphadenectomy for rectal adenocarcinoma.  Dis Colon Rectum. 1992;  35(12) 1143-1147
    CrossrefPubMedGoogle Scholar

Rocco RicciardiM.D. 

Department of Colon and Rectal Surgery, Lahey Clinic, 41 Mall Rd.

Burlington, MA 01805

Email: rocco.ricciardi@lahey.org

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