Skip to main content

Advertisement

SpringerLink
Log in

Perineal Wound Healing Following Ileoanal Pouch Excision

  • Original Article
  • Published:
Journal of Gastrointestinal Surgery

Abstract

Introduction

There is paucity of information relating to perineal wound healing when pouch failure after ileal pouch anal anastomosis necessitates pouch excision (PE). The aim of this study is to evaluate perineal healing and factors associated with the development of persistent perineal sinus (PPS) after PE.

Methods

Perineal wound-related outcomes for patients who underwent PE from 1985–2009 were evaluated by type of closure (extrasphincteric, intersphincteric, and sphincter-preserving (SP)) and other factors (presence of Crohn's disease (CD) and/or perineal fistulae). Primary outcomes were PPS and delayed healing (healing after PPS development).

Results

One hundred ten patients (CD 48 %) underwent PE. PPS occurred in 39.8 % patients, 51 % had delayed perineal healing with further procedures, with an overall healing rate of 80.7 %. Closure technique was not associated with PPS (p = 0.37) or eventual healing (p = 0.94). For CD patients, risk of PPS (41 vs. 39 %, p = 0.83) and delayed healing (44 vs. 59 %, p = 0.61) was similar to non-CD patients, but uncomplicated healing took longer (p = 0.04). Four of 15 (26.7 %) patients who underwent SP closure developed PPS; all eventually healed with secondary sphincter excision.

Conclusions

Perineal healing may be prolonged after pouch excision. Since eventual healing can be achieved in most patients, perineal dissection and closure can be tailored to the individual circumstance. Sphincter preservation may be used in non-CD patients if future reconstruction is possible. Extrasphincteric closure is preferable with cancer or perineal sepsis. Sphincter resection allows for complete healing in patients who undergo SP dissection and develop PPS.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Fazio VW, Tekkis PP, Remzi F, Lavery IC, Manilich E, Connor J, Preen M, Delaney CP. Quantification of risk for pouch failure after ileal pouch anal anastomosis surgery. Ann Surg 2003;238:605-614.

    PubMed  Google Scholar 

  2. Delaney CP, Fazio VW, Remzi FH, Hammel J, Church JM, Hull TL, Senagore AJ, Strong SA, Lavery IC. Prospective, age-related analysis of surgical results, functional outcome, and quality of life after ileal pouch-anal anastomosis. Ann Surg 2003;238:221-228.

    PubMed  Google Scholar 

  3. Hueting WE, Buskens E, van dT, I, Gooszen HG, van Laarhoven CJ. Results and complications after ileal pouch anal anastomosis: a meta-analysis of 43 observational studies comprising 9,317 patients. Dig Surg 2005;22:69-79.

    Article  PubMed  Google Scholar 

  4. Karoui M, Cohen R, Nicholls J. Results of surgical removal of the pouch after failed restorative proctocolectomy. Dis Colon Rectum 2004;47:869-875.

    Article  PubMed  Google Scholar 

  5. Lohsiriwat V, Clark SK. Persistent perineal sinus after ileoanal pouch excision in inflammatory bowel diseases: incidence, risk factors, and clinical course. Dis Colon Rectum 2008;51:1795-1799.

    Article  PubMed  Google Scholar 

  6. Prudhomme M, Dehni N, Dozois RR, Tiret E, Parc R. Causes and outcomes of pouch excision after restorative proctocolectomy. Br J Surg 2006;93:82-86.

    Article  CAS  PubMed  Google Scholar 

  7. Gurland B, Alves-Ferreira PC, Sobol T, Kiran RP. Using technology to improve data capture and integration of patient-reported outcomes into clinical care: pilot results in a busy colorectal unit. Dis Colon Rectum 2010;53:1168-1175.

    Article  PubMed  Google Scholar 

  8. Achkar JP, Al Haddad M, Lashner B, Remzi FH, Brzezinski A, Shen B, Khandwala F, Fazio V. Differentiating risk factors for acute and chronic pouchitis. Clin Gastroenterol Hepatol 2005;3:60-66.

    Article  PubMed  Google Scholar 

  9. Moskowitz RL, Shepherd NA, Nicholls RJ. An assessment of inflammation in the reservoir after restorative proctocolectomy with ileoanal ileal reservoir. Int J Colorectal Dis 1986;1:167-174.

    Article  CAS  PubMed  Google Scholar 

  10. Pemberton JH, Kelly KA, Beart RW, Jr., Dozois RR, Wolff BG, Ilstrup DM. Ileal pouch-anal anastomosis for chronic ulcerative colitis. Long-term results. Ann Surg 1987;206:504-513.

    CAS  Google Scholar 

  11. Watts JM, De Dombal FT, Goligher JC. Long-term complications and prognosis following major surgery for ulcerative colitis. Br J Surg 1966;53:1014-1023.

    Article  CAS  PubMed  Google Scholar 

  12. Kiran RP, Kirat HT, Rottoli M, Xhaja X, Remzi FH, Fazio VW. Permanent ostomy after ileoanal pouch failure: pouch in situ or pouch excision? Dis Colon Rectum 2012;55:4-9.

    Article  PubMed  Google Scholar 

  13. Veress B, Reinholt FP, Lindquist K, Lofberg R, Liljeqvist L. Long-term histomorphological surveillance of the pelvic ileal pouch: dysplasia develops in a subgroup of patients. Gastroenterology 1995;109:1090-1097.

    Article  CAS  PubMed  Google Scholar 

  14. Lohsiriwat V. Persistent perineal sinus: incidence, pathogenesis, risk factors, and management. Surg Today 2009;39:189-193.

    Article  PubMed  Google Scholar 

  15. Yamamoto T, Bain IM, Allan RN, Keighley MR. Persistent perineal sinus after proctocolectomy for Crohn’s disease. Dis Colon Rectum 1999;42:96-101.

    Article  CAS  PubMed  Google Scholar 

  16. Keighley MR, Allan RN. Current status and influence of operation on perianal Crohn’s disease. Int J Colorectal Dis 1986;1:104-107.

    Article  CAS  PubMed  Google Scholar 

  17. Anderin C, Martling A, Lagergren J, Ljung A, Holm T. Short term outcome after gluteus maximus myocutaneous flap reconstruction of the pelvic floor following extra-levator abdominoperineal excision of the rectum. Colorectal Dis 2011.

    Google Scholar 

  18. Chan S, Miller M, Ng R, Ross D, Roblin P, Carapeti E, Williams AB, George ML. Use of myocutaneous flaps for perineal closure following abdominoperineal excision of the rectum for adenocarcinoma. Colorectal Dis 2010;12:555-560.

    Article  CAS  PubMed  Google Scholar 

Download references

Disclaimers

None

Author information

Authors and Affiliations

  1. Department of Colorectal Surgery, Cleveland Clinic Foundation, 9500 Euclid Ave., Cleveland, OH, USA

    Pasha J. Nisar, Matthias Turina, Ian C. Lavery & Ravi P. Kiran

Authors
  1. Pasha J. Nisar
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Matthias Turina
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ian C. Lavery
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Ravi P. Kiran
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ravi P. Kiran.

Additional information

This study was shortlisted for the British Journal of Surgery prize at the 2011 ACPGBI meeting, Birmingham, UK

Rights and permissions

Reprints and permissions

About this article

Cite this article

Nisar, P.J., Turina, M., Lavery, I.C. et al. Perineal Wound Healing Following Ileoanal Pouch Excision. J Gastrointest Surg 18, 200–207 (2014). https://doi.org/10.1007/s11605-013-2340-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11605-013-2340-0

Keywords

Search

Navigation