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Healing of the perineal wound after proctectomy in Crohn’s disease patients: only preoperative perineal sepsis predicts poor outcome

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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Correspondence to S. A. Strong.

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Conflict of interest

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.

Ethical approval

All applicable ethical standards were followed in the conduct of the study and preparation of the manuscript.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Additional information

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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Keywords

  • Crohn’s disease
  • Proctectomy
  • Proctocolectomy
  • Perineal wound
  • Healing