Abstract
Background
The aim of our study was to assess perineal wound healing in patients with Crohn’s disease (CD) who undergo proctectomy or proctocolectomy with end ileostomy and to evaluate the influence of various factors including types of perineal dissection on eventual wound healing.
Methods
Data for patients with CD who underwent proctectomy or total proctocolectomy with end ileostomy from 1995 to 2012 were reviewed. The relationship between perineal wound healing and demographics, patient characteristics, and other factors was assessed using univariate and multivariate analyses.
Results
The perineal wound healed by 12 weeks in 72 (52.9%) out of 136 patients (63.2% female, mean age 41 ± 13 years); delayed healing occurred in 35 patients (25.7%), and in 29 patients (21.3%), there was non-healing. On multivariate analysis, the only factor associated with delayed healing and non-healing was preoperative perineal sepsis (p = 0.001).
Conclusions
After proctectomy or proctocolectomy for CD, perineal wound healing is poor and poses a particular challenge for patients with preoperative perineal sepsis. These findings support a preoperative discussion regarding CD patients that examines potential outcomes and the consideration of measures such as the initial creation of defunctioning ostomy or control/drainage of local sepsis prior to proctectomy.
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References
Fry RD, Shemesh EI, Kodner IJ, Timmcke A (1989) Technique and results in the management of anal and perianal Crohn’s disease. Surg Gynecol Obster 168:42–48
van Dongen LM, Lubbers EJ (1986) Perianal fistulas in patients with Crohn’s disease. Arch Surg 121:1187–1190
Buchmann P, Keighley MR, Allan RN, Thompson H, Alexander Williams J (1980) Natural history of perineal Crohn’s disease: en year follow up: a plea for conservatism. Am J Surg 168:42–48
Williamson PR, Hellinger MD, Larach SW, Ferrara A (1995) Twenty-year review of the surgical management of perianal Crohn’s disease. Dis Colon Rectum 38:389–392
Williams JG, Rothenberger DA, Nember FD, Goldberg SM (1991) Fistula in ano in Crohn’s disease. Results of aggressive surgical treatment. Dis Colon Rectum 34:378–384
Basu A, Wexner SD (2002) Perianal Crohn’s disease. Curr Treat Options Gasteroenterol 5:197–206
Anthony JP, Mathes SJ (1990) The recalcitrant perineal wound after rectal extirpation. Arch Surg 125:1371–1377
Broader JH, Masselink BA, Oates GD, Alexander Williams J (1974) Management of the pelvic space after proctectomy. Br J Surg 61:94–97
Irvin TT, Goligher JC (1975) A controlled clinical trial of three different methods of perineal wound management following excision of the rectum. Br J Surg 62:287–291
Baudot P, Keight MR, Alexander-Williams J (1980) Perineal wound healing after proctectomy for carcinoma and inflammatory disease. Br J Surg 67:275–276
Lubbers E-JC (1982) Healing of the perineal wound after proctectomy for nonmalignant conditions. Dis Colon Rectum 25:351–357
Scammell BE, Keighley MR (1986) Delayed perineal wound healing after proctectomy for Crohn’s disease. Br J Surg 73:150–152
Marks CG, Ritchie JK, Todd IP, Wadsworth J (1978) Primary suture of the perineal wound following rectal excision for inflammatory bowel disease. Br J Surg 65:560–564
Beck DE (2001) Management of anorectal Crohn’s fistulas. Clin Colon Rectal Surg 14:117–128
Tompkins RG, Warshaw AL (1985) Improved management of the perineal wound after proctectomy. Ann Surg 202:760–765
Althumairi AA, Canner JK, Gearhart SL et al (2016) Risk factors for wound complications after abdominoperineal excision: analysis of the ACS NSQIP database. Colorectal Dis 18:0260–0266
Asplund D, Prytz M, Bock D, Haglind E, Angenete E (2015) Persistent perineal morbidity is common following abdominoperineal excision for rectal cancer. Int J Colorectal Dis 30:1563–1570
Musters GD, Sloothaak DA, Roodbeen S, van Geloven AA, Bemelman WA, Tanis PJ (2014) Perineal wound healing after abdominoperineal resection for rectal cancer: a two-centre experience in the era of intensified oncological treatment. Int J Colorectal Dis 29:1151–1157
Yamamoto T, Bain IM, Allan RN, Keighley MRB (1999) Persistent perineal sinus after proctocolectomy for Crohn’s disease. Dis Colon Rectum 42:96–101
Corman MI, Veidenheimer MC, Coller JA, Ross VH (1978) Perineal wound healing after proctectomy for inflammatory bowel disease. Dis Colon Rectum 21:155–159
Zeitels JR, Fiddian-Green RG, Dent TL (1984) Intersphincteric proctectomy. Surgery 96:617
Bardot P, Keighley MRB, Alexander-Williams J (1980) Perineal wound healing after proctectomy for carcinoma and inflammatory disease. Br J Surg 67:275–276
De Dombal FT, Burton I, Goligher JC (1971) The early and late results of surgical treatment for Crohn’s disease. Br J Surg 58:805
Bertucci Zoccali M, Biondi A, Krane M et al (2015) Risk factors for wound complications in patients undergoing primary closure of the perineal defect after total proctectomy. Int J Colorectal Dis 30:87–95
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This manuscript has been seen and approved by all authors. The authors have no conflicts of interest including relevant financial interests, activities, relationships, and affiliations.
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All applicable ethical standards were followed in the conduct of the study and preparation of the manuscript.
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Informed consent was obtained from all individual participants included in the study.
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This study was conducted at the Cleveland Clinic.
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Li, W., Stocchi, L., Elagili, F. et al. Healing of the perineal wound after proctectomy in Crohn’s disease patients: only preoperative perineal sepsis predicts poor outcome. Tech Coloproctol 21, 715–720 (2017). https://doi.org/10.1007/s10151-017-1695-8
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DOI: https://doi.org/10.1007/s10151-017-1695-8