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10 Strategies for prevention of perineal wound dehiscence after intersphincteric proctectomy for perianal Crohn's

Stefan D Holubar1, Phil Tozer2

  • 1Department of Colon and Rectal Surgery, Cleveland Clinic, Cleveland Clinic Lerner College of Medicine and Case Western Reserve University, 9500 Euclid Ave, A30, ClevelandCleveland, OH, 44122, USA. holubas@ccf.org.

Techniques in Coloproctology
|May 25, 2026
PubMed

Insights

Preventing non-healing perineal wounds after intersphincteric proctectomy for Crohn's disease requires optimizing patient health, managing disease activity, and employing specific surgical techniques. These ten strategies aim to reduce wound complications and improve patient outcomes.

Area of Science:

  • Gastroenterology
  • Colorectal Surgery
  • Wound Healing

Background:

  • Non-healing perineal wounds (NHPWs) are a frequent complication post-intersphincteric proctectomy (ISP) for fistulizing perianal Crohn's disease (pCD).
  • These complications significantly impact quality of life and increase healthcare costs.
  • Current healing rates for NHPWs after ISP are approximately 70% at one year.

Purpose of the Study:

  • To review current evidence and expert practices for preventing perineal wound dehiscence after ISP for pCD.
  • To present ten pragmatic strategies to reduce NHPWs.
  • To provide a framework for minimizing surgical complications in pCD patients.

Main Methods:

  • Narrative review of contemporary evidence and expert practice.
  • Identification and summarization of ten key preventative strategies.
  • Focus on preoperative optimization, disease activity control, and operative techniques.

Main Results:

  • Preoperative optimization includes nutritional correction, anemia management, smoking cessation, and comorbidity control.
  • Active Crohn's disease management involves staging, drug monitoring, and sepsis control.
  • Key operative strategies include ISP with total mesorectal excision, meticulous fistula management, multilayered closure, and adjunctive therapies like omental flaps and negative pressure wound therapy.

Conclusions:

  • A multidisciplinary approach combining patient optimization, disease control, and refined surgical techniques is crucial.
  • Implementing these ten strategies can significantly reduce the incidence of perineal wound complications.
  • Improved wound healing post-ISP for pCD enhances patient quality of life and reduces healthcare utilization.

Keywords:
Crohn’s diseaseIncisional negative pressure wound therapyOmental pedicled flapOmentoplastyPerianal fistulaePerineal wound dehiscencePresacral sinusProctectomy

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