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Diseases of the Colon & Rectum

, Volume 35, Issue 10, pp 975–980 | Cite as

Low Hartmann's procedure for severe anorectal Crohn's disease

  • Marc E. Sher
  • Joel J. Bauer
  • Stephen Gorphine
  • Irwin Gelernt
Original Contributions

Abstract

Perineal wounds often fail to heal following proctectomy for Crohn's disease. Twenty-five patients with severe anorectal Crohn's disease and perineal fistulas, necessitating excisional surgery, underwent a low Hartmann's procedure in lieu of a standard proctectomy. Fifteen of the 25 (60 percent) patients had a completely healed perineum and required no further surgical therapy. Although perineal disease persisted in the other 10 patients, their perinea were much improved compared with the initial presentation. Following a low Hartmann's procedure, the rectal stump becomes atrophic and anoperineal disease regresses, thereby permitting subsequent perineal proctectomy in less inflamed tissues. Since only a 3-cm to 5-cm cuff of rectum was retained from the initial surgery, a perineal intersphincteric approach could be employed and no abdominal dissection was necessary. Of the 10 patients who subsequently underwent perineal proctectomies, three patients still have an unhealed perineum. Twenty-two of the 25 (88 percent) patients have a completely healed perineum (mean follow-up period, 69.1 months). No attempt was made to establish intestinal continuity in any of the 25 patients. We conclude that the problem of the unhealed perineal wound can be averted with this approach, thereby reducing the long-term morbidity to the patient.

Key words

Crohn's disease Perineal wound healing Hartmann's procedure 

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Copyright information

© American Society of Colon and Rectal Surgeons 1992

Authors and Affiliations

  • Marc E. Sher
    • 1
  • Joel J. Bauer
    • 1
  • Stephen Gorphine
    • 1
  • Irwin Gelernt
    • 1
  1. 1.Department of Surgery, Mount Sinai Hospital, Mount Sinai School of MedicineThe City University of New YorkNew York

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