Long-term perineal wound healing and re-operation rates after proctectomy in patients with inflammatory bowel disease—A retrospective multicentre study

Abstract

Background and Aims: Perineal wound complications occur frequently after proctectomy in patients with inflammatory bowel disease (IBD), with persistent perineal wounds appearing in some patients. This study examines the surgical outcomes after proctectomy in patients with IBD in a contemporary setting, with primary perineal wound healing as the primary end-point. Methods: This is a multicentre retrospective cohort study with five Swedish hospitals participating. Patients with IBD who had undergone proctectomy during the period of 2000–2019 were included. Two exposures of interest were analysed: type of IBD, either ulcerative colitis (UC) or Crohn's disease (CD), and indication for surgery. Perineal wound healing was assessed at 3, 6, 12, and 24 months postoperatively. Multilevel binomial regression with complementary log–log link function was used to estimate healing over discrete time intervals, and a separate analysis concerning fistulising disease and healing was conducted. Results: In total, 408 patients (57% males, 56% with UC) were included. Refractory proctitis was the most common indication for surgery in both UC (50%) and CD (38%) patients. The 2-year overall healing rate was 91%, with 95% in the UC group and 86% in the CD group. Patients with CD had a significantly slower adjusted healing rate (HR 0.67, 95% CI 0.53; 0.85). Anal fistulas as an indication for proctectomy showed significantly lower odds of healing over the entire period compared with proctitis (OR = 0.31, p = 0.036). Conclusions: Perineal wound morbidity with formation of chronic sinuses remains a problem after proctectomy in patients with IBD, primarily in patients with CD and especially those with anal fistulas.