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Primary vs myocutaneous flap closure of perineal defects following abdominoperineal resection for colorectal disease: a systematic review and meta-analysis.
Yang, X Y; Wei, M T; Yang, X T; He, Y Z; Hao, Y; Zhang, X B; Deng, X B; Wang, Z Q; Zhou, Z Q.
Afiliação
  • Yang XY; Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, China.
  • Wei MT; Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, China.
  • Yang XT; Wound Care Center, West China Hospital, Sichuan University, Chengdu, China.
  • He YZ; Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, China.
  • Hao Y; West China School of Public Health, Sichuan University, Chengdu, China.
  • Zhang XB; Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, China.
  • Deng XB; Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, China.
  • Wang ZQ; Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, China.
  • Zhou ZQ; Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, China.
Colorectal Dis ; 21(2): 138-155, 2019 02.
Article em En | MEDLINE | ID: mdl-30428157
ABSTRACT

AIM:

Perineal wound complications after abdominoperineal resection (APR) have become a major clinical challenge. Myocutaneous flap closure has been proposed in place of primary closure to improve wound healing. We conducted this comprehensive meta-analysis to evaluate the current scientific evidence of primary closure vs myocutaneous flap closure of perineal defects following APR for colorectal disease.

METHODS:

We systematically searched the MEDLINE, Embase, PubMed, Web of Science and Cochrane Library databases to identify all relevant studies. After data extraction from the included studies, meta-analysis was performed to compare perioperative outcomes of primary closure and myocutaneous flap closure.

RESULTS:

Eighteen studies with a total of 17 913 patients (16 346 primary closure vs 1567 myocutaneous flap closure) were included. We found that primary closure was significantly associated with higher total perineal wound complications (P = 0.007), major perineal wound complications (P < 0.001) and perineal wound infection (P = 0.001). On the other hand, myocutaneous flap closure takes more operation time (P < 0.001) and increases the risk of perineal wound dehiscence (P = 0.01), deep surgical site infection (P < 0.001), enterocutaneous fistulas (P = 0.03) and return to the operating room (P = 0.0005). There were no significant differences between the two groups for other outcomes.

CONCLUSIONS:

This is the first systematic review with meta-analysis comparing primary closure with myocutaneous flap closure of perineal defects after APR for colorectal disease. Although taking more operation time and an increased risk of specific complications, the pooled results have validated the use of myocutaneous flaps for reducing total/major perineal wound complications. More investigations are needed to draw definitive conclusions on this dilemma.
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Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Períneo / Complicações Pós-Operatórias / Deiscência da Ferida Operatória / Cirurgia Colorretal / Procedimentos de Cirurgia Plástica / Retalho Miocutâneo Tipo de estudo: Systematic_reviews Limite: Humans Idioma: En Revista: Colorectal Dis Assunto da revista: GASTROENTEROLOGIA Ano de publicação: 2019 Tipo de documento: Article País de afiliação: China

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Períneo / Complicações Pós-Operatórias / Deiscência da Ferida Operatória / Cirurgia Colorretal / Procedimentos de Cirurgia Plástica / Retalho Miocutâneo Tipo de estudo: Systematic_reviews Limite: Humans Idioma: En Revista: Colorectal Dis Assunto da revista: GASTROENTEROLOGIA Ano de publicação: 2019 Tipo de documento: Article País de afiliação: China