Primary vs. delayed perineal proctectomy—there is no free lunch

Vitaliy Poylin*, Thomas Curran, Daniel Alvarez, Deborah Nagle, Thomas Cataldo

*Corresponding author for this work

Research output: Contribution to journalArticle

2 Scopus citations

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.

Original languageEnglish (US)
Pages (from-to)1207-1212
Number of pages6
JournalInternational Journal of Colorectal Disease
Volume32
Issue number8
DOIs
StatePublished - Aug 1 2017

Keywords

  • Abdominoperineal resection
  • Perineal proctetomy
  • Wound infection

ASJC Scopus subject areas

  • Gastroenterology

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