Langenbeck's Archives of Surgery

, Volume 402, Issue 7, pp 1063–1069 | Cite as

Persistent perineal sinus after abdominoperineal resection

  • Amélie Chau
  • Mathieu Prodeau
  • Hélène Sarter
  • Corinne Gower
  • Moshe Rogosnitzky
  • Yves Panis
  • Philippe Zerbib
ORIGINAL ARTICLE
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Abstract

Background and aims

Persistent perineal sinus (PPS) defined as a perineal wound remaining unhealed more than 6 months after abdominoperineal resection (APR) is a well-known complication. The aim of our study was (1) to evaluate the incidence of PPS after APR for Crohn’s disease (CD) in the era of biotherapy, (2) to determine long-term outcome of PPS, (3) to study risk factors associated with delayed perineal healing, and (4) to compare the results in this CD patient group with patients without CD.

Methods

From 1997 to 2013, the records of patients who underwent APR for CD and for non-CD rectal cancer with or without radiochemotherapy at two French university hospitals were studied retrospectively. Perineal healing was evaluated by clinical examination at 1, 6, and 12 months after surgery.

Results

The cumulative probability of perineal wound unhealed at 6 and 12 months after surgery was 85 and 48%, respectively, for 81 patients who underwent APR for CD patients in contrast to 21 and 13%, respectively, for 25 non-CD patients with rectal cancer. Eight patients with CD (10%) remained with PPS after a median follow up of 4 years and spontaneous perineal healing occurred with time for all non-CD patients. Factors associated with delayed perineal healing in CD included age at surgery < 49 years (p = 0.001) and colonic-only Crohn’s disease location (p = 0.045). Medical treatments had no significant impact on perineal healing.

Conclusions

PPS beyond 6 months post-APR remains a frequent complication but mostly resolves over time. CD is a risk factor for developing PPS and factors associated with higher incidence of PPS were age at surgery < 49 years and colonic-only Crohn’s disease location. Prevention of PPS in this population with muscle flap during APR deserves to be evaluated.

Keywords

Crohn’s disease Abdominoperineal resection Persistent perineal sinus 

Abbreviations

Anti-TNF

Anti-tumor necrosis factor

APL

Anoperineal lesion

APR

Abdominoperineal resection

ASA

American Society of Anesthesiologists

BMI

Body mass index

CD

Crohn’s disease

IQR

Interquartile range

PPS

Persistent perineal sinus

RCT

Radiochemotherapy

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Notes

Acknowledgements

The authors thank Carol A. Bienstock for assistance with manuscript preparation.

Author’s contributions

Amélie Chau contributed to the concept and study design, acquisition and interpretation of data, and drafting the manuscript. Mathieu Prodeau contributed to the interpretation of data and statistical analysis. Hélène Sarter contributed to the interpretation of data and statistical analysis. Corinne Gower-Rousseau contributed to the interpretation of data and drafting and critical revision of the manuscript. Moshe Rogosnitzky contributed to the interpretation of data and drafting and critical revision of the manuscript. Yves Panis contributed to the interpretation of data and drafting and critical revision of the manuscript. Philippe Zerbib contributed to the concept and study design, acquisition of data, interpretation of data, and drafting and critical revision of the manuscript.

Funding

None.

Compliance with ethical standards

Disclosures

The authors have no conflicts of interest to disclose.

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Copyright information

© Springer-Verlag GmbH Germany 2017

Authors and Affiliations

  • Amélie Chau
    • 1
  • Mathieu Prodeau
    • 1
  • Hélène Sarter
    • 2
    • 3
  • Corinne Gower
    • 2
    • 3
  • Moshe Rogosnitzky
    • 1
  • Yves Panis
    • 4
  • Philippe Zerbib
    • 1
    • 3
  1. 1.Digestive Surgery and Transplantation UnitHôpital Huriez, Lille Nord de France University, Lille University Medical CenterLilleFrance
  2. 2.Public Health, Epidemiology, Economic Health, and Biostatistics Unit, Registre Epimad, Maison Régionale de la Recherche CliniqueCentre Hospitalier Universitaire RégionalLille CEDEXFrance
  3. 3.Lille Inflammation Research International Center LIRIC - UMR 995 Inserm/Université Lille 2/CHRU de Lille; Equipe « IBD and environmental factors: Epidemiology and functional analyses »Lille UniversityLilleFrance
  4. 4.Department of Colorectal Surgery, Pôle des Maladies de l’Appareil Digestif (PMAD), Beaujon Hospital, Assistance publique-Hôpitaux de Paris (AP-HP)Université Denis Diderot (Paris VII)ClichyFrance

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