Abdominoperineal and anterior resection of the rectum with retrocolic omentoplasty and no drainage

Forty consecutive patients scheduled for either low anterior resection or abdominoperineal resection of the rectum have been studied. After standard procedures, carried out by all grades of surgeons, the omentum was mobilized as a pedicle graft based on the left gastro-epiploic arcade and transposed to the pelvis or perineum. All wound were closed primarily without drainage. Twenty-six patients had anterior resection, 11 abdominoperineal resection and 3 an extended Hartmann's operation. Patients were assessed clinically and radiographically by Gastrografin enema and ultrasound for evidence of anastomotic leakage, pelvic collections and wound healing. After anterior resection there were three radiological leaks and no overt clinical leaks. One patient had a collection related to a leak. Of 11 perineal wound 8 healed primarily in 2 weeks and all healed by 4 weeks. There was no frank wound breakdown. The three patients who had Hartmann's operations all healed without complication. There were no unavoidable complications of the procedure. Retrocolic omentoplasty is a simple, safe and effective adjunct to rectal surgery. The additional time taken (15-20 min) is well rewarded by sound healing of these operations.