Primary closure and continuous irrigation of the perineal wound after proctectomy

The aim was to assess the success of primary closure and continuous irrigation of the perineal wound in achieving wound healing after proctectomy. The frequency and degree of primary healing (dry wound within 30 days after removal of irrigation catheters) and the factors affecting the rate of healing were determined in 152 patients undergoing proctectomy for carcinoma (31 patients), Crohn's colitis (32 patients), or ulcerative colitis (89 patients). All patients were followed for at least 2 years. Primary healing occurred in 64.5% of patients, whereas it was delayed (dry wound by 90 days) or failed to occur in 30.2% and 5.3%, respectively. Of those with carcinoma, 87% had healing by 30 days, whereas only 61% and 50% of those with either ulcerative colitis or Crohn's disease, respectively, had healing in that time (P less than 0.02). Females had primary healing more often than males (70% versus 45%, P less than 0.01), and the incidence of persistent perineal sinus was greater in men (28%) than in women (13%) (P less than 0.05). Primary healing was adversely affected in men when drains exited centrally through the wound (31% healed primarily) as opposed to when they exited laterally (65% healed primarily, P less than 0.04). We conclude that primary closure with irrigation of the perineal wound is safe and provides satisfactory healing in most patients.