P434 Close rectal versus total mesorectal excision in patients with inflammatory bowel disease undergoing proctocolectomy or completion proctectomy
J. de Groof*, O. van Ruler, P. Tanis, W. Bemelman, C. Buskens
Academic Medical Centre, Surgery, Amsterdam, Netherlands
Proctocolectomy or completion proctectomy in inflammatory bowel disease (IBD) patients is frequently complicated by disturbed perineal wound healing and presacral abscess formation. It has been hypothesised that the close rectal dissection (CRD) could reduce this complication by leaving the rectal mesentery in situ to minimise the dead space cavity when compared with the standard total mesorectal excision (TME). However, in Crohn’s disease (CD) patients, mesenteric adipose tissue has been associated to CD etiopathology with reduced migratory potential in wound healing fibroblast. The aim of this study was to compare perineal wound healing in ulcerative colitis (UC) and CD patients undergoing TME or CRD.
Adult patients undergoing proctocolectomy or completion proctectomy without reconstruction for UC or CD between January 2005 and August 2015 were included in this retrospective cohort study. Endpoints were postoperative perineal complications, and healing at 6 and 12 months.
In total, 56 IBD patients (16 UC and 40 CD) were included (44.6% male), with a mean age at surgery of 44.0 years (± 14.0). CRD was performed in 7 UC patients (43.8%) and 31 CD patients (77.5%). In UC patients, significantly fewer perineal complications (18.8% versus 47.5%, p = 0.05) and a higher healing rate at 6 months (87.5% versus 65%, p = 0.09) were seen when compared with CD patients. There were no significant differences in outcome between the 2 surgical techniques in the UC patient group. Perineal complications occurred less frequently in CD patients who underwent TME when compared with CRD, (22.2% versus 54.8%, p = 0.08), with higher healing rates at 6 months after TME resection (88.9% versus 58.1%, p = 0.09). Perineal healing rate at 12 months was 66.7% in the CRD group versus 87.5% in the TME group (p = 0.44). Healing rates in the TME group were comparable between UC and CD patients. Omentalplasty was done in two-thirds of the CD patients who underwent TME. Patients with omentalplasty had perineal wound complications in one-third versus none in patients without omental plasty (p = 0.26). Healing rates were comparable at 6 and 12 months in both groups (83.3% and 80.0% with omental plasty versus 100% without (p = 0.45 and p = 0.41).
In UC patients undergoing proctocolectomy or completion proctectomy, there were significantly less perineal complications when compared with CD patients with higher healing rates. More than 50% of CD patients had perineal complications and impaired healing, which was seen more frequently after CRD when compared with TME. Performing an omental plasty in combination with TME resection did not improve outcome in this series.