Vitaliy Poylin1, Thomas Curran2, Daniel Alvarez2, Deborah Nagle2, Thomas Cataldo2. 1. Department of Surgery, Division of Colon and Rectal Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA. vpoylin@bidmc.harvard.edu. 2. Department of Surgery, Division of Colon and Rectal Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
Abstract
PURPOSE: Perineal wound complications associated with anorectal excision are associated with prolonged wound healing and readmission. In order to avoid these problems, the surgeon may choose to leave the anorectum in situ. The purpose of this study is to compare complications and outcomes after primary vs. delayed anorectum removal. METHODS: A retrospective review of all patients undergoing proctectomy or proctocolectomy with permanent stoma between 2004 and 2014 in a single tertiary institution was conducted. RESULTS: During the study period, we identified 117 proctectomy patients; 69 (59%) patients had anorectum removed at index operation and 41% had the anorectum left in place. Patients with retained anorectum developed pelvic abscess significantly more frequently as compared to the other group (23 vs. 4%, p = 0.003). In patients with primary anorectum removal, 22 (32%) had perineal complications and 10 (15%) required reoperations. In patients with retained anorectum, 12 patients (25%) came back for delayed perineal proctectomy at a mean time of 277 days after the index operation; 7 of those (58%) developed postoperative wound complications. There was no difference in time to perineal wound healing between primary and delayed perineal proctectomy group (154 vs. 211 days, p = 0.319). CONCLUSION: Surgery involving the distal rectum is associated with a significant number of infectious perineal complications. Although leaving the anorectum in place avoids a primary perineal wound, both approaches are associated with a significant number of complications including reoperation.
PURPOSE: Perineal wound complications associated with anorectal excision are associated with prolonged wound healing and readmission. In order to avoid these problems, the surgeon may choose to leave the anorectum in situ. The purpose of this study is to compare complications and outcomes after primary vs. delayed anorectum removal. METHODS: A retrospective review of all patients undergoing proctectomy or proctocolectomy with permanent stoma between 2004 and 2014 in a single tertiary institution was conducted. RESULTS: During the study period, we identified 117 proctectomy patients; 69 (59%) patients had anorectum removed at index operation and 41% had the anorectum left in place. Patients with retained anorectum developed pelvic abscess significantly more frequently as compared to the other group (23 vs. 4%, p = 0.003). In patients with primary anorectum removal, 22 (32%) had perineal complications and 10 (15%) required reoperations. In patients with retained anorectum, 12 patients (25%) came back for delayed perineal proctectomy at a mean time of 277 days after the index operation; 7 of those (58%) developed postoperative wound complications. There was no difference in time to perineal wound healing between primary and delayed perineal proctectomy group (154 vs. 211 days, p = 0.319). CONCLUSION: Surgery involving the distal rectum is associated with a significant number of infectious perineal complications. Although leaving the anorectum in place avoids a primary perineal wound, both approaches are associated with a significant number of complications including reoperation.
Authors: Caprice K Christian; Mary R Kwaan; Rebecca A Betensky; Elizabeth M Breen; Michael J Zinner; Ronald Bleday Journal: Dis Colon Rectum Date: 2005-01 Impact factor: 4.585