Perineal wound complications after proctectomy for Crohn’s disease: the impact of the omental pedicle flap and predictors of return to the operating room

Background

The role of omental pedicle flaps (OPFs) in reducing the risk of perineal wound complications and postoperative pelvic abscesses in patients with Crohn’s disease remains unclear. This study aimed to determine whether OPFs had any effect on the incidence of perineal wound complications requiring a return to the operating room (OR) or the requirement for radiologic-guided drainage of pelvic abscesses in patients with Crohn’s disease who underwent proctectomy.

Methods

This was a retrospective, single-center study. The study included patients who underwent proctectomy for Crohn’s disease with primary perineal closure, with or without an OPF. The primary outcome measures were return to the OR for perineal wound complications or the requirement for radiologically guided drainage of pelvic abscesses.

Results

A total of 219 patients (71 with flap and 148 without flap) underwent proctectomy during the study period. No differences were observed in the rate of unplanned return to the OR (11.27% in the OPF group vs 9.46% in the non-OPF group; P =.81) or the number of patients requiring radiologically guided drainage of pelvic abscesses (11.27% in the OPF group vs 6.76% in the non-OPF group, respectively; P =.30) between the cohorts. Patients in the flap cohort were more likely to have a history of tobacco use (P =.02), fistulizing perianal disease (P =.01), undergo extrasphincteric dissection (P =.03), and use incisional wound vacuum assisted closure (VAC) at the time of surgery (P =.02).

Conclusion

Careful patient selection for the OPF might play a role in reducing wound complications to a level similar to that observed in patients with lower-risk perineal wounds.