Omentoplasty for persistent perineal sinus after proctectomy for Crohn's disease.

Persistent perineal sinus is a common and serious cause of morbidity after proctectomy for Crohn's disease. Recently we have performed excision and omentoplasty on 6 patients with persistent perineal sinus. The perineal sinus was completely excised and communication was established with the pelvis. In 4 patients, the left gastroepiploic vessels were divided close to their origins and in 2 other patients the right gastroepiploic vessels were divided. The omentum was brought down to the perineum and it was lightly sutured to the perineal skin. After a median follow-up of 28 months, the perineal sinus had healed in 5 patients. In 1 patient the omentum became necrotic and infected 1 month after omentoplasty, and this patient still has a complex sinus. Although the number of patients is small, omentoplasty may be an effective procedure for the treatment of persistent perineal sinus after proctectomy for Crohn's disease.