Persistent perineal sinus: incidence, pathogenesis, risk factors, and management

Area of Science:

• Surgical outcomes
• Wound healing
• Gastrointestinal surgery complications

Background:

• Persistent perineal sinus (PPS) is a challenging complication, defined as a perineal wound unhealed >6 months post-surgery.
• Incidence varies significantly, reaching 3-70% after inflammatory bowel disease (IBD) surgery and up to 30% after abdominoperineal resection (APR) for rectal cancer.

Purpose of the Study:

• To review the incidence, pathogenesis, risk factors, diagnosis, and therapeutic options for persistent perineal sinus (PPS).
• To provide a comprehensive overview of current management strategies for this complex surgical complication.

Main Methods:

• Literature review of studies on persistent perineal sinus.
• Analysis of incidence, risk factors, and diagnostic approaches.
• Evaluation of current and emerging therapeutic interventions.

Main Results:

• PPS is frequently associated with perioperative pelvic or perineal sepsis.
• Key risk factors include Crohn's disease (CD) and neoadjuvant radiation therapy.
• Therapeutic options range from topical treatments and vacuum-assisted closure to reconstructive surgery.

Conclusions:

• Effective management of PPS necessitates a thorough understanding of its underlying pathogenesis and clinical presentation.
• A multidisciplinary approach is often required to address the complexities of persistent perineal sinus.
• Further research into standardized treatment protocols may improve patient outcomes.