Primary perineal closure after proctocolectomy for inflammatory bowel disease: Prevention of the persistent perineal sinus

Abstract

In seventeen patients who had a proctocolectomy for ulcerative or granulomatous colitis, the levator muscles and perineal tissues were sutured primarily. In all patients the pelvic peritoneum was left open to allow the remaining intestine to fill the pelvic space. In eight patients in whom the pelvic space was not drained, uncomplicated healing occurred in five, but the other three patients developed infected pelvic collections leading to delayed perineal wound healing. In the subsequent nine patients in whom the pelvic space was drained, all patients had uncomplicated healing. There has been no instance of perineal hernia or intestinal obstruction during four years' observation. This method of managing the pelvic space and perineal wound, based upon obviating all blood or serum collections, has been simple, safe, comfortable, and effective in eliminating the prolonged morbidity of an unhealed perineal wound.