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Journal of Gastrointestinal Surgery

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01-01-2014 | Original Article

Perineal Wound Healing Following Ileoanal Pouch Excision

Authors: Pasha J. Nisar, Matthias Turina, Ian C. Lavery, Ravi P. Kiran

Published in: Journal of Gastrointestinal Surgery | Issue 1/2014

Abstract

Introduction

There is paucity of information relating to perineal wound healing when pouch failure after ileal pouch anal anastomosis necessitates pouch excision (PE). The aim of this study is to evaluate perineal healing and factors associated with the development of persistent perineal sinus (PPS) after PE.

Methods

Perineal wound-related outcomes for patients who underwent PE from 1985–2009 were evaluated by type of closure (extrasphincteric, intersphincteric, and sphincter-preserving (SP)) and other factors (presence of Crohn's disease (CD) and/or perineal fistulae). Primary outcomes were PPS and delayed healing (healing after PPS development).

Results

One hundred ten patients (CD 48 %) underwent PE. PPS occurred in 39.8 % patients, 51 % had delayed perineal healing with further procedures, with an overall healing rate of 80.7 %. Closure technique was not associated with PPS (p = 0.37) or eventual healing (p = 0.94). For CD patients, risk of PPS (41 vs. 39 %, p = 0.83) and delayed healing (44 vs. 59 %, p = 0.61) was similar to non-CD patients, but uncomplicated healing took longer (p = 0.04). Four of 15 (26.7 %) patients who underwent SP closure developed PPS; all eventually healed with secondary sphincter excision.

Conclusions

Perineal healing may be prolonged after pouch excision. Since eventual healing can be achieved in most patients, perineal dissection and closure can be tailored to the individual circumstance. Sphincter preservation may be used in non-CD patients if future reconstruction is possible. Extrasphincteric closure is preferable with cancer or perineal sepsis. Sphincter resection allows for complete healing in patients who undergo SP dissection and develop PPS.

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Title: Perineal Wound Healing Following Ileoanal Pouch Excision
Authors: Pasha J. Nisar
Matthias Turina
Ian C. Lavery
Ravi P. Kiran
Publication date: 01-01-2014
Publisher: Springer US
Published in: Journal of Gastrointestinal Surgery / Issue 1/2014
Print ISSN: 1091-255X
Electronic ISSN: 1873-4626
DOI: https://doi.org/10.1007/s11605-013-2340-0

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Perineal Wound Healing Following Ileoanal Pouch Excision

Abstract

Introduction

Methods

Results

Conclusions

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Abstract

Introduction

Methods

Results

Conclusions

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