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Background: For patients with Crohn's disease (CD) undergoing proctectomy with or without colectomy and end ileostomy, while the procedure may relieve debilitating symptoms and improve quality of life, postoperative perineal wound complications can be a persistent problem. The aim of our study is to assess perineal wound healing in patients with 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.
Patients and Methods: Data for patients with CD who underwent total proctocolectomy or proctectomy with end ileostomy from 1995-2012 were reviewed. Perineal wound healing was classified as follows: Early healing (within 12 weeks), delayed healing (between 12 weeks and 6 months) and persistent sinus (unhealed >6 months).
Result: For 139 patients (63% female), mean age 41 ±13 years, perineal wound healed by 12 weeks in 74 (53%) patients, delayed healing occurred in 36 (25.9%) patients, and in 29 (20.9 %) patients, there was a persistent sinus. Perineal dissection was either intersphincteric or extrasphincteric depending upon the extent of perineal Crohn's / sepsis, extensive disease managed by leaving the wounds open. Factors associated with a significantly greater risk for perineal sinus were age (p<0.001), surgical management of perineal wound by open drainage (p=0.04), high fistula (p=0.01), preoperative perineal sepsis / disease (p=0.001) and smoking at time of surgery (p=0.03). On multivariate analysis, the only factor associated with delayed healing and persistent sinus was preoperative perineal sepsis and disease (P=0.001).
Conclusion: The perineal wound after proctectomy or proctocolectomy for CD is associated with poor healing and poses a particular challenge for patients with extensive preoperative perineal disease or sepsis. These findings support a preoperative discussion that examines potential outcomes and the consideration of measures such as the initial creation of a defunctioning ostomy, control/drainage of local sepsis and appropriate medical treatment prior to proctectomy in CD patients considered to be at high risk for perineal wound problems.