The reply:

Abstract

We welcome the measured comments by Dr Bascom and support his hypothesis that stitches in ditches don’t heal. We would always consider a local and less invasive procedure as a means of curing the persistent perineal sinus and would nearly always explore this approach before proceeding with a major abdomino perineal exposure and omentoplasty. The problem with perineal procedures is that the persistent sinus is normally 7 to 10 cm long, and when it has been excised, one is left with a large cavity that must be filled if it is to heal. For the long perineal sinus, we think that the radical approach that we describe is likely to be more successful than perineal procedures alone.