Persistent perineal sinus after proctocolectomy for Crohn's disease

Yamamoto, Takayuki; Bain, I. M.; Allan, Robert; Keighley, M. R. B.

doi:10.1007/bf02235190

Cited by 118 publications

(67 citation statements)

References 17 publications

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“…In the present study complete excision of the anal sphincters at the time of pouch excision produced better immediate results in patients with Crohn's disease and recurrent sepsis. In contrast, in other series the extent of sphincteric resection did not have an influence on perineal healing after pouch excision 14 or proctectomy for Crohn's disease 30 .…”

Section: Discussionmentioning

confidence: 93%

Causes and outcomes of pouch excision after restorative proctocolectomy

Prudhomme

Dehni

Dozois

et al. 2006

Journal of British Surgery

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Section: Discussionmentioning

confidence: 93%

Causes and outcomes of pouch excision after restorative proctocolectomy

Prudhomme

Dehni

Dozois

et al. 2006

Journal of British Surgery

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“…Up to 25% of patients undergoing proctectomy for CD will develop a persistent perineal sinus. 58,59 Sinuses can cause pain, offensive discharge, occasional bleeding, and be very uncomfortable for patients. There are two main reasons why patients develop persistent perineal wound problems after a proctectomy for CD.…”

Section: Difficult Perineal Woundmentioning

confidence: 99%

Perioperative complications in inflammatory bowel disease

Beddy

Dozois

Pembérton

2011

Inflammatory Bowel Diseases

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Almost 50% of patients with inflammatory bowel disease (IBD) will undergo surgery for their disease at some stage of its clinical course. Complications seen following surgery may occur early or late in the postoperative period. Patient factors, including active inflammatory disease, malnutrition, and use of immunosuppressant medications, make these patients a challenging surgical group and at increased risk for surgical complications. The purpose of this review is to characterize the complications that are commonly seen following surgery in patients with IBD and to discuss the surgical and patient factors that may influence their development.

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“…Some of these wounds which fail, might result in a chronic discharging sinus [9]. Another complication related to completion proctectomy in CD patients, is a pelvic collection [10]. These collections may be managed conservatively or with intervention in the form of radiological guided aspiration, depending on the size and the sinuses with the use of video assisted anal fistula treatment (VAAFT) technique.…”

Section: Discussionmentioning

confidence: 99%

Transanal total mesorectal excision (TaTME) for inflammatory bowel disease (IBD): review of technique and initial experience

et al. 2017

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IntroductionTrans anal minimal invasive surgery (TAMIS) is a novel technique gaining popularity in colorectal surgery due to its precision in pelvic dissection and easy accessibility to the distal rectum. Its use in colorectal cancer surgery is well documented although inflammatory bowel disease (IBD) poses a unique set of disease-specific and procedure-related challenges. Unlike in cancer surgery, the wide disease spectrum with varying morphological changes in IBD would require the surgeon to adapt accordingly from port insertion to wound closure. This article describes our experience with the first 60 procedures. MethodologyPatients affected by IBD requiring proctectomy with or without total colectomy from 2013 to 2016 were offered Trans anal total mesorectal excision (TaTME) on a TAMIS and Single Incision Laparoscopy (SILS) combined platform. Airseal ® insufflation on GelpointPath ® platform with monopolar diathermy was used for rectal surgery. A second team using ultrasonic dissection carried out concomitant abdominal dissection. Procedural modifications were adopted based on authors' personal experience. Standard ileoanal S pouch with stapler anastomosis was performed. Surgical time, blood loss and patient demographics were recorded. ResultsAll 60 patients (male -44; median age 42.5; range 19-75) presented during the study period underwent TaTME for the rectal dissection with an 8% conversion rate. Of the total 38 (63%) were done for ulcerative colitis and the perineal phase has taken a median time of 141.8 minutes. Ileo-anal pouch surgery was performed in 27 (45%) patients. Two patients (3.3%) required re-intervention due to complications in the abdominal procedure. Two patients required vacuum dressing for wound closure. ConclusionTaTME is a safe and feasible procedure in IBD surgery. Specific difficulties due to the inflammatory process which results in difficult dissection can be overcome with attention to anatomical details and the use of specific instruments. 1,2 2 2 2

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Persistent perineal sinus after proctocolectomy for Crohn's disease

Abstract: Persistent perineal sinus is more likely to occur if an extrasphincteric dissection is needed because of extensive anorectal disease or if fecal contamination occurs at operation. Attempted surgical eradication of perineal sinus is often ineffective.

Cited by 118 publications

References 17 publications

Causes and outcomes of pouch excision after restorative proctocolectomy

Causes and outcomes of pouch excision after restorative proctocolectomy

Perioperative complications in inflammatory bowel disease

Transanal total mesorectal excision (TaTME) for inflammatory bowel disease (IBD): review of technique and initial experience

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