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Proctectomy in Patients with “Watering Can” Perineum

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Mastery of IBD Surgery

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Abstract

Perineal wound complications are common after proctectomy for inflammatory bowel disease (IBD). The failure of initial primary healing of perineal wound ranges from 2% to 45% in ulcerative colitis (UC) and up to 36% in Crohn’s disease (CD). The presence of perineal sepsis due to extensive perineal fistulas, the so-called “watering can” perineum, can further complicate healing after proctectomy and contribute to delay in perineal wound closure. While most perineal wounds heal over time, some result in the development of a chronic perineal sinus. The incidence of perineal sinus formation may be as high as 50% in ulcerative colitis and 62% in Crohn’s disease.

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References

  1. Corman ML, Veidenheimer MC, Coller JA, Ross VH. Perineal wound healing after proctectomy for inflammatory bowel disease. Dis Colon Rectum. 1978;21(3):155–9.

    Article  CAS  Google Scholar 

  2. Baudot P, Keighley MR, Alexander-Williams J. Perineal wound healing after proctectomy for carcinoma and inflammatory disease. J Br J Surg. 1980;67(4):275–6.

    Article  CAS  Google Scholar 

  3. Yamamoto T, Mylonakis E, Keighley MR. Omentoplasty for persistent perineal sinus after proctectomy for Crohn’s disease. Am J Surg. 2001;181(3):265–7.

    Article  CAS  Google Scholar 

  4. Yamamoto T, Bain IM, Allan RN, Keighley MR. Persistent perineal sinus after proctocolectomy for Crohn’s disease. Dis Colon Rectum. 1999;42(1):96–101.

    Article  CAS  Google Scholar 

  5. Hurst RD, Gottlieb LJ, Crucitti P, Melis M, Rubin M, Michelassi F. Primary closure of complicated perineal wounds with myocutaneous and fasciocutaneous flaps after proctectomy for Crohn’s disease. Surgery. 2001;130(4):767–72; discussion 772–3.

    Article  CAS  Google Scholar 

  6. Brough WA, Schofield PF. The value of the rectus abdominis myocutaneous flap in the treatment of complex perineal fistula. Dis Colon Rectum. 1991;34(2):148–50.

    Article  CAS  Google Scholar 

  7. Sumrien H, Newman P, Burt C, McCarthy K, Dixon A, Pullyblank A, Lyons A. The use of a negative pressure wound management system in perineal wound closure after extralevator abdominoperineal excision (ELAPE) for low rectal cancer. Tech Coloproctol. 2016;20(9):627–31.

    Article  CAS  Google Scholar 

  8. Musters GD, Klaver CEL, Bosker RJI, Burger JWA, van Duijvendijk P, van Etten B, van Geloven AAW, de Graaf EJR, Hoff C, Leijtens JWA, Rutten HJT, Singh B, Vuylsteke RJCLM, de Wilt JHW, Dijkgraaf MGW, Bemelman WA, Tanis PJ. Biological mesh closure of the pelvic floor after extralevator abdominoperineal resection for rectal cancer: a multicenter randomized controlled trial (the BIOPEX-study). Ann Surg. 2017;265(6)

    Article  Google Scholar 

  9. Sher ME, BauerJJ GS, Gelemt I. Low Hartmann’s procedure for severe anorectal Crohn’s disease. Dis Colon Rectum. 1992;35:975–80.

    Article  CAS  Google Scholar 

  10. Cirincione E, Gorfine SR, Bauer JJ. Is Hartmann’s procedure safe in Crohn’s disease? Report of three cases. Dis Colon Rectum. 2000;43(4):544–7.

    Article  CAS  Google Scholar 

  11. Poylin V, Curran T, Alvarez D, Nagle D, Cataldo T. Primary vs. delayed perineal proctectomy-there is no free lunch. Int J Colorectal Dis. 2017;32(8):1207–12.

    Article  Google Scholar 

  12. Li W, Stocchi L, Elagili F, Kiran RP, Strong SA. Healing of the perineal wound after proctectomy in Crohn’s disease patients: only preoperative perineal sepsis predicts poor outcome. Tech Coloproctol. 2017;21(9):715–20.

    Article  CAS  Google Scholar 

  13. Ip B, Jones M, Bassett P, Phillips R. Factors affecting the healing of the perineum following surgery. Ann R Coll Surg Engl. 2013;95(4):252–7.

    Article  CAS  Google Scholar 

  14. Adam IJ, Shorthouse AJ. Perineal wound morbidity following proctectomy for inflammatory bowel disease (IBD). Colorectal Dis. 2000;2(3):165–9.

    Article  CAS  Google Scholar 

  15. Tompkins RG, Warshaw AL. Improved management of the perineal wound after proctectomy. Ann Surg. 1985;202(6):760–5.

    Article  CAS  Google Scholar 

  16. Yamamoto T, Allan RN, Keighley MR. Audit of single-stage proctocolectomy for Crohn’s disease: postoperative complications and recurrence. Dis Colon Rectum. 2000;43(2):249–56.

    Article  CAS  Google Scholar 

  17. Lubbers EJ. Healing of the perineal wound after proctectomy for nonmalignant conditions. Dis Colon Rectum. 1982;25(4):351–7.

    Article  CAS  Google Scholar 

  18. Scammell BE, Keighley MR. Delayed perineal wound healing after proctectomy for Crohn’s colitis. Br J Surg. 1986;73(2):150–2.

    Article  CAS  Google Scholar 

  19. Kamrava A, Mahmoud NN. Prevention and management of nonhealing perineal wounds. Clin Colon Rectal Surg. 2013;26(2):106–11.

    Article  Google Scholar 

  20. Bertucci Zoccali M, Biondi A, Krane M, Kueberuwa E, Rizzo G, Persiani R, Coco C, Hurst RD, D’Ugo D, Fichera A. Risk factors for wound complications in patients undergoing primary closure of the perineal defect after total proctectomy. Int J Colorectal Dis. 2015;30(1):87–95. https://doi.org/10.1007/s00384-014-2062-0.

    Article  PubMed  Google Scholar 

  21. Mihes Y, Hogan NM, Egan L, Joyce MR. Completion proctectomy for Crohn’s colitis: lessons learned. J Crohns Colitis. 2017;11(7):894–7.

    Article  Google Scholar 

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Authors and Affiliations

  1. University of Chicago, Chicago, IL, USA

    Konstantin Umanskiy

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  1. Konstantin Umanskiy
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Correspondence to Konstantin Umanskiy .

Editor information

Editors and Affiliations

  1. Colon and Rectal Surgery, University of Chicago, Chicago, IL, USA

    Neil Hyman

  2. Section of Colon and Rectal Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA

    Phillip Fleshner

  3. Feinberg School of Medicine, Northwestern University, Chicago, IL, USA

    Scott Strong

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Umanskiy, K. (2019). Proctectomy in Patients with “Watering Can” Perineum. In: Hyman, N., Fleshner, P., Strong, S. (eds) Mastery of IBD Surgery. Springer, Cham. https://doi.org/10.1007/978-3-030-16755-4_13

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  • DOI: https://doi.org/10.1007/978-3-030-16755-4_13

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-16754-7

  • Online ISBN: 978-3-030-16755-4

  • eBook Packages: MedicineMedicine (R0)

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