Abstract
A retrospective review was conducted of 326 patients undergoing intersphincteric rectal excision for ulcerative colitis. Seventy-five patients (Group A) had rectal excision with closure of the pelvic peritoneum and packing of the pelvic space via an open perineal wound. One hundred sixty-nine patients (Group B) had excision without pelvic peritoneal closure, but with the levators and subcutaneous tissue closed and with transabdominal sump suction drainage of the pelvic space. Complete healing for Groups A and B occurred by three months in 42 and 79 percent, respectively, and by six months in 56 and 89 percent. Thirty-one percent of Group A and 9 percent of Group B were unhealed at one year, and/or required further surgery. When all 326 patients were considered, healing was achieved at three, six, and 12 months, for packed and for closed wounds, in 42 percent and 79 percent, 55 percent and 89 percent, 66 percent and 91 percent, respectively. All these differences are highly significant (P<0.0001). The incidence of small-bowel obstruction requiring surgery during follow-up was similar whether the pelvic peritoneum was closed (15.5 percent) or left open (15.7 percent). Other factors which adversely affected perineal wound healing were younger age, a short history of disease, a two-stage proctocolectomy especially for persistent severe rectal disease, and the presence of perianal disease.
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Waugh JM, Peck DA, Beahrs OH, Sauer WG. Surgical management of chronic ulcerative colitis. Arch Surg 1964;88:556–69.
Watts JMcK, de Dombal FT, Goligher JC. Early results of surgery for ulcerative colitis. Br J Surg 1966;53:1005–23.
Jalan KN, Smith AN, Ruckley CV, Falconer CW, Small WP, Prescott RJ. Perineal wound healing in ulcerative colitis. Br J Surg 1969;56:749–53.
Turnbull RB, Fazio V. Advances in the surgical technique of ulcerative colitis surgery: endoanal proctectomy and two-directional myotomy ileostomy. Surg Annu 1975;315–29.
Lee EC, Dowling BL. Perimuscular excision of the rectum for Crohn's disease and ulcerative colitis. Br J Surg 1972;59:29–32.
Lyttle JA, Parks AG. Intersphincteric excision of the rectum. Br J Surg 1977;64:413–6.
Baudot P, Keighley MR, Alexander-Williams J. Perineal wound healing after proctectomy for carcinoma and inflammatory disease. Br J Surg 1980;67:275–6.
Broader JH, Masselink BA, Oates GD, Alexander-Williams J. Management of the pelvic space after proctectomy. Br J Surg 1974;61:94–7.
Hulten L, Kewenter J, Knutsson U, Olbe L. Primary closure of perineal wound after proctocolectomy or rectal excision. Acta Chir Scand 1971;137:467–9.
Schwab PM, Kelly KA. Primary closure of the perineal wound after proctectomy: a new technique. Mayo Clin Proc 1974;49:176–9.
Goligher JC. The management of the perineal wound after protectomy. In: Varco RL, Delaney JP, eds. Controversies in surgery II. Philadelphia: WB Saunders, 1983:304–9.
Ray AA. SAS users' guide: basis. Cary SAS Institute, 1983.
Hughes ES. The treatment of ulcerative colitis. Ann R Coll Surg Engl 1965;37:191–206.
Corman ML, Veidenheimer MC, Coller JA, Ross VH. Perineal wound healing after proctectomy for inflammatory bowel disease. Dis Colon Rectum 1978;21:155–9.
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Oakley, J.R., Fazio, V.W., Jagelman, D.G. et al. Management of the perineal wound after rectal excision for ulcerative colitis. Dis Colon Rectum 28, 885–888 (1985). https://doi.org/10.1007/BF02554295
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DOI: https://doi.org/10.1007/BF02554295