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    
Abstract/OtherAbstract:
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 (clinicaltrials.gov: 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.
Authors:
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    
Affiliation:
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. n.s.williams@qmul.ac.uk
Data Bank Information
Bank Name/Acc. No.:
ClinicalTrials.gov/NCT00534131
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Anal Canal / physiopathology
Cohort Studies
Colitis, Ulcerative / physiopathology,  surgery*
Digestive System Surgical Procedures / methods*
Female
Humans
Ileostomy
Male
Middle Aged
Perineum / surgery*
Pilot Projects
Recovery of Function
Rectal Neoplasms / pathology,  physiopathology,  surgery*
Rectum / injuries*,  surgery*
Treatment Outcome
Comments/Corrections
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


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