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Njoumi N(1), Tarchouli M(1), Ratbi MB(1), Elochi MR(2), Yamoul R(1), Hachi H(1),  Bougtab A(1).


Author information:

(1)Service de chirurgie II, Institut National d’Oncologie, CHU Ibn Sina, Faculté  de Medecine et de Pharmacie de Rabat, Maroc.

(2)Service d’anatomie pathologique, HMIMV, Rabat, Maroc.


DOI: 10.11604/pamj.2013.16.131.2864

PMCID: PMC4024435

PMID: 24847393  [Indexed for MEDLINE]


Pan Afr Med J. 2013 Dec 8;16:131. doi: 10.11604/pamj.2013.16.131.2864. eCollection 2013.

Souadka A(1), Majbar MA, Bougutab A, El Othmany A, Jalil A, Ahyoud FZ, El Malki HO, Souadka A.


Author information:

(1)1 University Mohammed Vth Souissi, Rabat, Medical School, Surgical Department,

National Institute of Oncology, Rabat, Morocco 2 University Mohammed Vth Souissi,

Rabat, Medical School, Department of General Surgery, Rabat, Morocco 3 University

Mohammed Vth Souissi, Rabat, Medical School, Medical Center of Clinical Trials and Epidemiological Study (CRECET), Rabat, Morocco 4 Cheikh Zaid Ibn Soltan

Foundation, Cheikh Zaid International University Hospital, Rabat, Morocco 5 Surgical Department, Al Azhar Oncological Center, Rabat, Morocco.


BACKGROUND: Pseudocontinent perineal colostomy is one of the techniques that helps recover the body image of patients undergoing abdominoperineal resection. This technique is rarely used internationally given its unknown functional results.

OBJECTIVE: The study aimed to evaluate 1-year functional outcomes of perineal pseudocontinent colostomy and to determine the risk factors for “poor” functional results.

DESIGN: This study is a retrospective interventional case series.

SETTINGS: This study was conducted at a tertiary care university hospital and oncological center in Morocco.

PATIENTS: From January 1993 to December 2007, 149 patients underwent pseudocontinent perineal colostomy after abdominoperineal resection for low rectal adenocarcinoma.

INTERVENTION: Pseudocontinent perineal colostomy was performed with the use of the Schmidt technique after abdominoperineal resection.

MAIN OUTCOME MEASURES: One-year functional results were assessed according to the Kirwan classification system. Functional results were considered “poor” when the  Kirwan score was C, D, or E. Univariable and multivariable analyses were used to  evaluate the impact of age, sex, type of surgery, irrigation frequency, palpable  muscular ring, concomitant chemoradiotherapy, stage, and perineal complications on functional results.

RESULTS: One hundred forty-six patients were analyzed. According to the Kirwan system, the scores showed that 100 (68.5%) patients had “good” continence results (stage A-B) and 46 (31.5%) patients had altered functional results (stage C-D-E). With the exception of pelvic recurrences, no conversions from a perineal colostomy to an abdominal colostomy were performed for dissatisfactory functional results. In multivariate analysis, the only independent predictive factors of poor functional results were the occurrence of perineal complications (OR, 3.923; 95% CI, 1.461-10.35; p = 0.007) and extended resection (OR, 3.03; 95% CI, 1.183-7.750; p = 0.021) LIMITATION OF THE STUDY:: This study is an observational  retrospective study on selected patients (mainly a young population).

CONCLUSIONS: This study showed that perineal complications and extended resection are associated with poor functional results after pseudocontinent perineal colostomy. These data can help clinicians to better inform patients about the outcomes of this technique and to assist them in choosing the right reconstruction technique after abdominoperineal resection.


DOI: 10.1097/DCR.0b013e31829f8cd5

PMID: 24022531  [Indexed for MEDLINE]


Dis Colon Rectum. 2013 Oct;56(10):1143-8. doi: 10.1097/DCR.0b013e31829f8cd5.

Majbar MA, Elmalki Hadj O, Souadka A, El Alaoui M, Sabbah F, Raiss M, Hrora A, Ahallat M.


BACKGROUND: Anastomotic leakage (AL) is an important cause of morbidity after surgery for rectal cancer.

AIM: to analyze the risk factors associated with anastomotic leakage after anterior resection for rectal adenocarcinoma.

METHODS: We collected data from all the patients who had surgical resection with  an anastomosis, for rectal adenocarcinoma at the Surgical Clinic C (Ibn Sina Hospital, Rabat, Morocco), between January 2001 and December 2010. The associations between variables and anastomotic leakage were studied using univariate and multivariate analysis.

RESULTS: Our study included 130 patients. Anastomotic leakage occurred in 28 patients (21.5%). Univariate and multivariate analysis showed that the rate of anastomotic leakage was significantly higher in patients who received preoperative radiotherapy (34.2% vs. 12 %, p = 0.002 – OR 3.8 – CI 95%: 1.5 – 9.4). There was no significant difference in the rate of AL between patients with or without a protective stoma. In the group of patients with AL, the rate of reoperation was significantly lower in patients with a stoma protection (31.8% vs 83.3%, p = 0.04).

CONCLUSION: Radiotherapy is a risk factor for anastomotic leakage. The systematic design of a protective stoma in patients receiving neoadjuvant radiotherapy is advisable to reduce the rate of reoperations associated with AL.


PMID: 25775290  [Indexed for MEDLINE]


Tunis Med. 2014 Jul;92(7):493-6.

Dahiri M, Salmi N, Ahallat A, El Bahaoui N, Belkouchi O, Souadka A, Majbar A, Benkabbou A, Bougtab A, Mohsine R.

AME Case Rep. 2018 Jun 14;2:31. doi: 10.21037/acr.2018.06.01. eCollection 2018.


Cervical cancer is the second most common cancer and the third cause of cancer death in women. Radiotherapy occupies a prominent place in the therapeutic arsenal of cervical cancer in localized stages. Radiation induced secondary cancer is an entity that has been well described in the literature. We report a case of a rectal adenocarcinoma occurring in a woman previously treated by radiotherapy and brachytherapy for a squamous cell carcinoma of the cervix.


Rectal cancer; cervical cancer; radiation induced cancer; secondary cancer

PMID: 30264027 / PMCID: PMC6155695.

DOI: 10.21037/acr.2018.06.01

Souadka A, Majbar MA, Benkabbou A, Serji B, Souiki T, Bouchentouf SM, Abid M, El Khannousi B, El Harroudi T, El Malki HO, Raiss M, Ifrine L, Mazaz K, Zentar A, Mohsine R, Souadka A, Belkouchi A, Ahallat M, Hrora A; Moroccan Society of Surgery.

BMC Cancer. 2019 Oct 28;19(1):1008. doi: 10.1186/s12885-019-6239-3.


Background: Many data suggest that patients with low rectal adenocarcinoma who achieved ypT0N0 status have improved survival and disease-free survival (DFS) compared to all other stages however only few data are available regarding the specific prognosis factors of this subgroup. This study aimed to evaluate predictive factors for disease free survival after complete pathological response (CPR) in cases of low rectal adenocarcinoma.

Materials and methods: From January 2005 to December 2013, all patients with low rectal adenocarcinoma who underwent neoadjuvant chemoradiotherapy followed by total mesorectal excision and achieved CPR were included at 7 Moroccan and 1 Algerian centres. Predictive factors for disease-free survival were analysed by uni and multivariate analysis.

Results: Eigthy-four (12.1%) patients achieved a CPR (ypT0N0). Multivariate analysis revealed that both poorly differentiated tumors (OR, 9.23; 95 CI 1.35-62.82; P = 0.023) and the occurrence of perineal sepsis (OR, 13.51; 95 CI 1.96-93.12; P = 0.008) were independently associated with impaired DFS.

Conclusions: Patients with low rectal cancer who exhibited a CPR after neoadjuvant therapy have good prognoses; however, the occurrence of perineal sepsis and/or poor initial differentiation may be associated with impaired DFS in these patients.

Trial registration: The study was retrospectively registered the 28th July 2018 in register with the reference NCT03601689.

Keywords: Complete pathological response; Disease-free survival; Neoadjuvant treatment; Predictive factors; Rectal neoplasm.

Souadka A(1), Majbar MA(2), El Harroudi T(3), Benkabbou A(3), Souadka A(3)(4).


Author information:

(1)Surgical Department, National Institut of Oncology, University Mohammed Vth Souissi, Rabat, Medical School, Rabat, Morocco.

(2)Department of General Surgery, University Mohammed Vth Souissi, Rabat, Medical School, Rabat, Morocco.

(3)Surgical Department, National Institut of Oncology, University Mohammed Vth Souissi, Rabat, Medical School, Rabat, Morocco.

(4)Surgical Department, Al Azhar Oncological Center, Rabat, Morocco.


BACKGROUND: The aim of this study was to evaluate oncologic results and satisfaction rate results of pseudocontinent perineal colostomy (PCPC) using Schmidt’s technique in patients undergoing abdominoperineal resection (APR) for managing low rectal adenocarcinoma.

METHODS: From January 1993 and December 2007, One hundred and forty six patients  underwent successfully PCPC after abdominoperineal resection for lower rectal adenocarcinoma. There were 75 women, with an average age of 47 years old. All patients received neoadjuvant radiotherapy with or without chemotherapy. Long-term oncological results and satisfaction rate were evaluated.

RESULTS: After a median follow up of 36 months (range 12-156) months, the five-year overall survival and disease free survival rate were 74.6% and 60.3% respectively. Local and distant recurrences occurred respectively in 10 (6,8%) and 29 (20%) patients. Seventy-seven percent (77%) of the patients were highly satisfied with this technique and only one patient was unsatisfied. However, none of them accepted the conversion to an abdominal colostomy neither would have changed PCPC for an iliac colostomy at first intent.

CONCLUSION: This study showed that pseudocontinent perineal colostomy is a safe and reliable pelvic reconstruction technique after abdominoperineal resection for low rectal adenocarcinoma. It provides high degree of patient satisfaction without compromising oncological results. It is a good option in selected patients, especially in Muslim countries.


DOI: 10.1186/s12893-015-0027-z

PMCID: PMC4406037

PMID: 25888423  [Indexed for MEDLINE]


BMC Surg. 2015 Apr 10;15:40. doi: 10.1186/s12893-015-0027-z.

Souadka A(1), Majbar MA(2), Amrani L(3), Souadka A(1).

Author information:

(1)a Surgical Department, Medical School, National Institute of Oncology , University Mohammed Vth Souissi, Rabat , Rabat , Morocco.

(2)b Department of General Surgery, Medical School , University Mohammed Vth Souissi, Rabat , Rabat , Morocco.

(3)c Gastroenterology Unit, Medical School, National Institute of Oncology , University Mohammed Vth Souissi, Rabat , Rabat , Morocco.

BACKGROUND AND STUDY AIM: The aim of this study was to analyze objectively the role of the muscular graft in the continence using manometric study in the patients who underwent pseudocontinent perineal colostomy after abdominoperineal  resection for rectal adenocarcinoma.

PATIENTS AND METHODS: This was a retrospective study including all the patients from January 2002 to December 2009 who underwent an abdominoperineal resection followed by perineal pseudocontinent colostomy for ultra-low rectal adenocarcinoma and agreed to perform the manometric evaluation of the muscular graft.

RESULTS: Fifteen patients were included, six males and nine females, with a mean  age of 50 years. According to Kirwan’s classification, 2 (13.3%) patients had normal continence (Stage A) had 10 (66.6%) no soiling (stage B) and 3 (20%) patients had minimal soiling (Stage C). The manometric evaluation was performed after a median period of 12 months post-surgery. The mean maximal resting and squeeze pressures were respectively 41 cmH2O and 59 cmH2O and the mean colonic sensory volume was 12 ml.

CONCLUSION: This study showed that the musculae graft of Pseudocontinent Perineal colostomy acted as a hypotonic sphincter that pressure can increase during the voluntary squeeze. These data may help to clarify the functional outcomes of this technique after APR for ultra-low rectal adenocarcinoma.

DOI: 10.1080/00015458.2016.1174020

PMID: 27472021  [Indexed for MEDLINE]

Acta Chir Belg. 2016 Oct;116(5):278-281. doi: 10.1080/00015458.2016.1174020. Epub 2016 Jul 29.

Souadka A(1), Majbar MA.


Author information:

(1)University Mohammed Vth Souissi and Surgical Department A, Ibn Sina Hospital,  Rabat, Morocco University Mohammed Vth Souissi; Surgical Department A, Ibn Sina Hospital and Medical Center of Clinical Trials and Epidemiological Study (CRECET), Rabat, Morocco.


Comment in J Wound Ostomy Continence Nurs. 2014 Jan-Feb;41(1):16.

Comment on J Wound Ostomy Continence Nurs. 2013 May-Jun;40(3):280-6.


DOI: 10.1097/01.WON.0000437014.90808.25

PMID: 24378688  [Indexed for MEDLINE]


J Wound Ostomy Continence Nurs. 2014 Jan-Feb;41(1):15-6. doi: 10.1097/01.WON.0000437014.90808.25.

Dumont F(1), Souadka A, Goéré D, Lasser P, Elias D.


Author information:

(1)Department of Surgery, Institut Gustave Roussy Cancer Center, Villejuif, France.

BACKGROUND: Abdominoperineal resections (APR) for anorectal tumors are associated with a high rate of perineal wound complications. The aim of this study was to evaluate the impact of pseudocontinent perineal colostomy (PPC) following APR on perineal wound healing.

METHODS: All patients undergoing APR between 2000 and 2009 were retrospectively reviewed. Perineal wound healing was compared between patients with PPC and those with perineal closure alone.

RESULTS: APR was performed in 132 patients, including 31 with PPC and 101 with no PPC. Risk factors such as radiotherapy, smoking, diabetes mellitus, and obesity were not different between the two groups. The PPC group had significantly fewer  cases of omentoplasty and adenocarcinoma histology. The overall perineal complication rate, perineal infection, or wound dehiscence was similar in the two groups, but the perineal healing rate at 6 and 12 weeks was significantly increased in the PPC group than in the non-PPC group (70.9% vs. 50%, P = 0.04, at 6 weeks; 90.3% vs. 73%, P = 0.04, at 12 weeks).

CONCLUSIONS: PPC accelerates perineal wound healing after APR without decreasing  the overall perineal complication rate.

Copyright © 2011 Wiley Periodicals, Inc.


DOI: 10.1002/jso.22105

PMID: 21953024  [Indexed for MEDLINE]


J Surg Oncol. 2012 Jun 1;105(7):628-31. doi: 10.1002/jso.22105. Epub 2011 Sep 22.

Majbar AM(1)(2), Abid M(3), Alaoui M(1)(2), Sabbah F(1)(2), Raiss M(1)(2), Ahallat M(1)(2), Hrora A(1)(2).

Author information:

(1)1 Surgery Department, Faculty of Medicine, Mohammed V University in Rabat , Rabat, Morocco .

(2)2 Surgical Unit C, Ibn Sina University Hospital , Rabat, Morocco .

(3)3 Surgery Unit, Anti Cancer Center , Batna, Algeria .

BACKGROUND: The impact of conversion to open surgery after a laparoscopic resection for rectal adenocarcinoma on postoperative morbidity is still unclear.

Most previous studies included colon and rectal carcinomas and produced conflicting results. The aim of this study was to investigate the impact of conversion to open surgery on early postoperative morbidity in patients who underwent a laparoscopic resection for rectal adenocarcinoma.

METHODS: This was a retrospective bicentric study. It included all consecutive patients who underwent a laparoscopic resection for nonmetastatic rectal adenocarcinoma between January 2005 and December 2013. The impact of conversion to open surgery on 30-day postoperative morbidity was analyzed by univariate and multivariate analyses. Risk factors for conversion were also investigated by univariate and multivariate analyses.

RESULTS: One hundred thirty-one patients were included. The conversion rate was 26.7%. The global 30-day morbidity rate was 31.3% (41 patients). The conversion to open surgery was associated with higher rates of postoperative complications,  anastomotic leaks, and reoperations. It was also an independent predictive factor to postoperative morbidity in the multivariate analysis (P = .01; odds ratio 2.86; 95% confidence interval [CI] 1.23-6.63), in addition to T4 tumors (P = .04; odds ratio 3.92; 95% CI 1.05-14.61). Risk factors for conversion in the multivariate analysis were T4 tumors (P = .006; odds ratio 6.09; 95% CI 1.66-22.32) and the height of the tumor (P = .025; odds ratio 2.7; 95% CI 1.13-6.43).

CONCLUSIONS: This study showed that conversion to open surgery after laparoscopic proctectomy for rectal adenocarcinoma was associated with higher rates of early postoperative complications. It also showed that T4 tumors and the height of the  tumor were independent factors associated with the conversion to open surgery.

Reducing postoperative morbidity could be achieved by a better patient selection and a policy of early conversion.

DOI: 10.1089/lap.2016.0027

PMID: 27388931  [Indexed for MEDLINE]

J Laparoendosc Adv Surg Tech A. 2016 Sep;26(9):697-701. doi: 10.1089/lap.2016.0027. Epub 2016 Jul 7.

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