# The Gamboa-Hoil Point for Primary Perineal Closure During Total Pelvic Exenteration

## TL;DR

This paper introduces a new technique for closing wounds after a complex surgery for pelvic cancer, showing it is safe and effective with low complications.

## Contribution

The Gamboa-Hoil point is a novel, standardized suture-based method for perineal closure after total pelvic exenteration.

## Key findings

- Perineal wound dehiscence and sinus formation occurred in 9.1% and 18.2% of patients, respectively.
- Tumor recurrence was observed in 18.2% of patients during a median follow-up of 20 months.
- Overall survival at study closure was 72.7% with a median hospital stay of seven days.

## Abstract

Introduction

Total pelvic exenteration (TPE) is a radical procedure for selected patients with advanced pelvic malignancies and is associated with significant perineal morbidity. Despite multiple reconstructive strategies, no consensus exists regarding the optimal strategy for perineal closure. The Gamboa-Hoil point is a standardized primary closure technique proposed by the authors, designed to reinforce perineal wound closure using a simple suture-based approach.

Methods

We conducted a single-center, retrospective descriptive study including patients with colorectal cancer (rectal, sigmoid colon, and selected locally advanced or recurrent anal canal tumors) who underwent TPE between January 2021 and December 2024. Primary perineal closure was performed using the Gamboa-Hoil point. The primary outcome was perineal morbidity, including wound dehiscence, surgical site infection, perineal sinus formation, and reintervention.

Results

Eleven patients (six men and five women) were included, with a median age of 60 years (range, 40-67). Negative surgical margins (R0) were achieved in all cases. No cases of infected pelvic fluid collections or postoperative intestinal obstruction were observed. A urinary fistula occurred in one patient (9.1%) and required minor reintervention with drain repositioning. Perineal wound dehiscence occurred in one patient (9.1%), and persistent perineal sinus formation was observed in two patients (18.2%). The median length of hospital stay was seven days. During a median follow-up of 20 months, tumor recurrence occurred in two patients (18.2%). Overall survival at study closure was 72.7%.

Conclusion

The Gamboa-Hoil point appears to be a feasible and reproducible option for primary perineal closure following TPE, with acceptable perineal morbidity in patients in whom primary closure is feasible.