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Persistent perineal sinus after proctocolectomy for Crohn's disease
T Yamamoto1, I M Bain, R N Allan
1University Department of Surgery, Queen Elizabeth Hospital, Edgbaston, Birmingham, United Kingdom.
Diseases of the Colon and Rectum
|April 22, 1999
Summary
Persistent perineal sinus after proctocolectomy for Crohn's disease is linked to younger age, rectal involvement, and fecal contamination. Surgical treatment for these sinuses is often ineffective, highlighting the need for preventative strategies.
Area of Science:
- Gastroenterology
- Colorectal Surgery
- Inflammatory Bowel Disease
Background:
- Persistent perineal sinus is a significant complication following proctocolectomy for Crohn's disease.
- This condition can lead to considerable patient morbidity.
Purpose of the Study:
- To identify factors contributing to persistent perineal sinus after proctocolectomy for Crohn's disease.
- To evaluate the effectiveness of surgical interventions for persistent perineal sinus.
Main Methods:
- Retrospective review of 145 patients who underwent proctocolectomy for Crohn's disease between 1970 and 1997.
- Analysis of patient factors and surgical outcomes related to persistent perineal sinus.
Main Results:
- Persistent perineal sinus occurred in 23% of patients.
- Risk factors included younger age, rectal involvement, perianal sepsis, high fistulas, extrasphincteric excision, and fecal contamination.
- Multivariate analysis identified age, rectal involvement, and fecal contamination as independent predictors.
- Surgical treatment for persistent sinus was often unsuccessful, with only 9 of 24 patients achieving healing.
Conclusions:
- Extrasphincteric dissection due to extensive disease and fecal contamination during operation increase the likelihood of persistent perineal sinus.
- Surgical attempts to eradicate persistent perineal sinus have a low success rate.