Introduction: Surgical treatment of perianal Paget's (PD) and Bowen's (BD) disease requires wide local excision of skin and subcutaneous tissue. Various techniques have been described to be feasible in repairing the resultant perianal defect. We assessed functional outcomes and QoL of patients undergoing repair of large perianal defects after wide local excision for PD and BD.
Methods: Between 1992 and 2004 at 2 institutions, 18 patients underwent repair of a defect involving at least half the circumference of the perianal region for PD (n=8) or BD (n=10) and were alive with intestinal continuity after 5-year median follow-up. Patients were mailed a standardized bowel function questionnaire, the fecal incontinence quality of life scale (FIQL) and the SF-36.
Results: Fourteen patients (78%) responded after a mean follow up of 7 years (Standard deviation 4). Median age was 61 years (range 48-84) with 12 females. Subcutaneous skin flaps (n=11) and split-thickness skin grafts (n=3) were used to repair the perianal defects, which were circumferential in 11 (78%). Responders were significantly older than nonresponders (mean age 64 vs. 50, P=0.02), but similar in gender, pathology and surgery type. Five patients did not report incontinence to either stool or mucous during the day or night. Nine patients reported some form of incontinence and completed the FIQL. The FIQL scores of patients reporting incontinence were lower for lifestyle (2.9 vs. 3.6, P<0.01), coping/behavior (2.5 vs. 3.3, P<0.01), and embarrassment (2.5 vs. 3.4, P=0.01), but not significantly different for depression (3.4 vs. 3.7, P=0.31) compared to controls without incontinence (Rockwood et al. Dis Colon rectum 2000;43:9-17). Mean SF-36 physical and mental summary scores of patients were not significantly different from the normative population (43 vs. 50, P=0.051 and 50 vs. 50, P=0.96) or between patients reporting incontinence and those who did not (41 vs. 48, P=0.30 and 49 vs. 52, P=0.76).
Conclusions: Functional results after repair of large perianal defects are acceptable and overall QoL is similar to normative population. A proportion of patients have some form of incontinence which impacts certain aspects of their QoL, although overall QoL is similar to patients without incontinence.