Healing of the Perineal Wound after Intersphincteric Dissection of the Rectum for Inflammatory Bowel Disease

Abstract

During the past 20 years a marked change in attitude to the surgical technique of removal of the rectum for inflammatory bowel disease has taken place among surgeons interested in colo-rectal surgery. This development has occurred in two main aspects of surgical technique. Firstly, the extent of removal of tissue from the pelvis has changed from standard abdomino-perineal excision techniques to a very conservative excision. In the second place, management of the perineal wound now consists of primary closure of the wound with closed drainage wherever possible, in contrast to previous methods of packing the perineum. Although close dissection of the rectum from the abdominal aspect has been advocated for many years, it is only relatively recently that Lyttle and Parks (1977) advocated very close dissection of the rectal wall from the perineal aspect. They suggested that an easy plane could be found in most patients between the internal sphincter (smooth muscle) and external sphincter (striated muscle) thus preserving intact the somatic sphincter apparatus and the muscles of the pelvic floor. It has been suggested that not only is nerve damage in the pelvis unlikely to occur during such a dissection but also the size of the cavity produced in the pelvis is small, with consequent reduction in dead space.