Document Detail

Anterior Perineal PlanE for Ultra-low Anterior Resection of the Rectum (the APPEAR technique): a prospective clinical trial of a new procedure.
MedLine Citation:
PMID:  18438111     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: The APPEAR procedure was developed to allow sphincter-preserving rectal resection for both benign and malignant pathology, which would traditionally require abdominoperineal excision or completion proctectomy, if treated by conventional means. This clinical trial ( NCT00534131) evaluated the short-term clinical and physiological results of this procedure. METHODS: Fourteen patients were enrolled, 7 with neoplasia, 5 with ulcerative colitis, and 2 with traumatic rectal damage. Patients were evaluated preoperatively, and at a median of 2 years after surgery. RESULTS: Nine of 14 patients underwent ileostomy reversal and were followed up for a minimum of 1 year, with 1 patient awaiting closure. Four patients have not yet been considered for ileostomy reversal due to anastomotic perineal fistulae. Transient sexual dysfunction was noted in 3 of 14 patients, but no urological problems occurred. When the APPEAR procedure was performed for neoplasia or trauma, postoperative median Wexner continence score was 5 (range 0-8, n = 6), with a median defecation frequency of 3 (range 1-8/day). All cancers were completely excised with no local recurrence. Following APPEAR with restorative proctocolectomy for ulcerative colitis, median Wexner continence score was 2 (range 0-6, n = 3), with a median daily defecatory frequency of 3 (range 1-5). Preoperative SF-36 scores did not change significantly following ileostomy closure, and anorectal physiological testing was unaltered following perineal dissection. CONCLUSIONS: The APPEAR procedure provides an alternative technique to effect an ultra-low sphincter-saving anastomosis, when this is not possible by conventional surgery. Morbidity was encountered and greater experience will be required to fully assess this approach. Nevertheless, this is a promising new procedure with the potential to reduce the need for a permanent stoma even further than is currently the case.
Norman S Williams; Jamie Murphy; Charles H Knowles
Publication Detail:
Type:  Clinical Trial; Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Annals of surgery     Volume:  247     ISSN:  1528-1140     ISO Abbreviation:  Ann. Surg.     Publication Date:  2008 May 
Date Detail:
Created Date:  2008-04-28     Completed Date:  2008-06-03     Revised Date:  2009-07-13    
Medline Journal Info:
Nlm Unique ID:  0372354     Medline TA:  Ann Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  750-8     Citation Subset:  AIM; IM    
Centre for Academic Surgery, Institute for Cell and Molecular Science, Barts and the London, Queen Mary's School of Medicine and Dentistry, University of London, London, United Kingdom.
Data Bank Information
Bank Name/Acc. No.:
Export Citation:
APA/MLA Format     Download EndNote     Download BibTex
MeSH Terms
Anal Canal / physiopathology
Cohort Studies
Colitis, Ulcerative / physiopathology,  surgery*
Digestive System Surgical Procedures / methods*
Middle Aged
Perineum / surgery*
Pilot Projects
Recovery of Function
Rectal Neoplasms / pathology,  physiopathology,  surgery*
Rectum / injuries*,  surgery*
Treatment Outcome
Comment In:
Ann Surg. 2009 Jul;250(1):174; author reply 174   [PMID:  19561464 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

Previous Document:  Training future surgical scientists: realities and recommendations.
Next Document:  Long-term benefits of Roux-en-Y pouch reconstruction after total gastrectomy: a randomized trial.