title: Perineal wound healing following ileoanal pouch excision.
abstract: BACKGROUND
  There is paucity of information relating to perineal wound healing when pouch failure after ileal pouch anal anastomosis necessitates pouch excision (PE). The aim of this study is to evaluate perineal healing and factors associated with the development of persistent perineal sinus (PPS) after PE.
  
  
  METHODS
  Perineal wound-related outcomes for patients who underwent PE from 1985-2009 were evaluated by type of closure (extrasphincteric, intersphincteric, and sphincter-preserving (SP)) and other factors (presence of Crohn's disease (CD) and/or perineal fistulae). Primary outcomes were PPS and delayed healing (healing after PPS development).
  
  
  RESULTS
  One hundred ten patients (CD 48 %) underwent PE. PPS occurred in 39.8 % patients, 51 % had delayed perineal healing with further procedures, with an overall healing rate of 80.7 %. Closure technique was not associated with PPS (p = 0.37) or eventual healing (p = 0.94). For CD patients, risk of PPS (41 vs. 39 %, p = 0.83) and delayed healing (44 vs. 59 %, p = 0.61) was similar to non-CD patients, but uncomplicated healing took longer (p = 0.04). Four of 15 (26.7 %) patients who underwent SP closure developed PPS; all eventually healed with secondary sphincter excision.
  
  
  CONCLUSIONS
  Perineal healing may be prolonged after pouch excision. Since eventual healing can be achieved in most patients, perineal dissection and closure can be tailored to the individual circumstance. Sphincter preservation may be used in non-CD patients if future reconstruction is possible. Extrasphincteric closure is preferable with cancer or perineal sepsis. Sphincter resection allows for complete healing in patients who undergo SP dissection and develop PPS.
authors.affiliation: Department of Colorectal Surgery, Cleveland Clinic Foundation, 9500 Euclid Ave., Cleveland, OH, USA.
authors.forename: Pasha J
authors.initials: PJ
authors.lastname: Nisar
authors.forename: Matthias
authors.initials: M
authors.lastname: Turina
authors.forename: Ian C
authors.initials: IC
authors.lastname: Lavery
authors.forename: Ravi P
authors.initials: RP
authors.lastname: Kiran
mesh_terms: D000328:Adult; D001003:Anal Canal / Q000601:surgery; D003093:Colitis, Ulcerative / Q000601:surgery; D039021:Colonic Pouches / Q000009:adverse effects*; D003424:Crohn Disease / Q000601:surgery*; D005260:Female; D005402:Fistula / Q000209:etiology / Q000601:surgery*; D006801:Humans; D053208:Kaplan-Meier Estimate; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D059351:Organ Sparing Treatments; D010502:Perineum / Q000503:physiopathology* / Q000601:surgery*; D011788:Quality of Life; D012086:Reoperation; D012189:Retrospective Studies; D018805:Sepsis / Q000209:etiology / Q000601:surgery; D013997:Time Factors; D058106:Wound Closure Techniques / Q000009:adverse effects*; D014945:Wound Healing