Abstract
The principal causes are disseminated coagulopathies related to prolonged sepsis and blood loss. With regard to blood loss, there are three delicate operative steps: careful dissection of the hypogastric venous trunk and its pelvic branches that may retract into the gluteal muscles, control of the periprostatic venous plexus of Santorini during anterior exenterations, and injury to the presacral venous plexus during abdominosacral resections. In case of uncontrollable bleeding, hemostatic pelvic packing may become indispensable. In major series, mean peroperative blood loss varying from 1000 to 7000 ml with extreme up to 25000 ml. No patients experienced dramatic perioperioperative outcome.
The main risk factors for onset of these complications include: a large perineal defect, prolonged duration of operative time, radiation therapy and postradiation fibrosis, and massive blood loss. Here TPE was associated with significant longer operative time and mean blood loss. Minor complication were pelvic abscess, intestinal obstruction, cardiovascular, renal, and pulmonary complications and major complication: enterocutaneous or enteroperineal fistulas and secondary perineal wound dehiscence, the most devastating, whose prevalence ranges from 4 to 24% in most of the large series with high rate of mortality. Immediate surgical treatment seems to be the best procedure. In our study, the patients with digestive leak underwent immediate re-operation and were discharged from hospital without septic disease.
