P394 Long-term perineal reoperation and wound healing after proctectomy or ileal pouch-anal anastomosis extirpation in patients with Inflammatory Bowel Disease – a retrospective multicentre study
Berghog, J.(1)*;Hermansson, M.(2);Risto, A.(3);Strömbäck, J.(4);Unger, D.(4);Gustafsson, H.(5);Hagavall, M.(6);Landerholm, K.(7);Buchwald, P.(8);Nordenvall, C.(9);Myrelid, P.(3);Block, M.(2);
(1)Institute of Clinical Sciences- Sahlgrenska Academy Gothenburg University- Gothenburg- Sweden, Department of Surgery- Sahlgrenska University Hospital/ Östra- Gothenburg- Sweden, Göteborg, Sweden;(2)Institute of Clinical Sciences- Sahlgrenska Academy Gothenburg University- Gothenburg- Sweden, Department of Surgery- Sahlgrenska University Hospital/Östra- Gothenburg- Sweden, Göteborg, Sweden;(3)Department of Clinical and Experimental Medicine- Linköping University- Linköping- Sweden, Department of Surgery- Linköping University Hospital- Linköping- Sweden, Linköping, Sweden;(4)Department of Molecular Medicine and Surgery- Karolinska Institutet- Stockholm- Sweden, Department of Molecular Medicine and Surgery- Karolinska Institutet- Stockholm- Sweden, Stockholm, Sweden;(5)Department of Surgery- Skåne University Hospital- Malmö- Sweden, Department of Surgery- Skåne University Hospital- Malmö- Sweden, Malmö, Sweden;(6)Department of Surgery- Ryhov county hospital- Jönköping- Sweden, Department of Surgery- Ryhov county hospital- Jönköping- Sweden, Jönköping, Sweden;(7)Department of Biochemical and Clinical Sciences- Linköping University- Linköping- Sweden, Department of Surgery- Ryhov county hospital- Jönköping, Jönköping, Sweden;(8)Department of Clinical Sciences Malmö- Lund University- Lund- Sweden, Department of Surgery- Skåne University Hospital- Malmö- Sweden, Malmö, Sweden;(9)Department of Molecular Medicine and Surgery- Karolinska Institutet- Stockholm- Sweden, Department of Pelvic Cancer- colorectal surgery unit- Karolinska University Hospital- Stockholm- Sweden, Stockholm, Sweden; Swedish Organization for the study of IBD (SOIBD)
Background
Patients with inflammatory bowel disease (IBD) may need to undergo proctectomy or ileal pouch-anal anastomosis (IPAA) extirpation with known short- and long-term perineal complications such as wound dehiscence, delayed healing, sinus formation and fistulas. This study aimed to examine perineal complications after proctectomy or IPAA extirpation.
Methods
This Swedish retrospective, multicentre study included IBD patients ≥18 years undergoing proctectomy or IPAA-extirpation between January 1st 2000 and December 31st 2019 at four hospitals. Medical records were reviewed and perineal wound healing was assessed at 3, 6, 12 and 24 months. Primary endpoint was need for perineal re-operation due to complications. Predefined factors associated with reoperation was assessed.
Results
Four hundred and fifty-one patients (257 males) were included in the study. After 3, 6, 12 and 24 months 70%, 75%, 80% and 88% had healed. Forty-nine (11%) patients underwent re-operation for perineal wound complication. Low age and short duration of IBD were significantly associated with the risk of reoperation (p<0.001 and p=0.032). Crohn´s disease was more common (55%) in the group that underwent re-operation compared to 41% in the no-reoperation group but not statistically significant (p=0.06). Most patients that underwent re-operation demonstrated a wound complication or perineal wound secretion within 30 days of surgery; 90% vs 48% ;p<0.001[KL1] and 80% vs 37%; p<0.001 [KL2] respectively. Following re-operation, the perineal wound healed in 45% (22/49).
Conclusion
At long-term follow-up 88% had healed perineal wound and only 11% had required perineal reoperation. Wound complications and secretion within 30 days of surgery seem unfavourable and predict reoperation and incomplete perineal healing.