Incidence and Risk Factors for Persistent Perineal Sinus After Proctectomy in Crohn Disease

OBJECTIVE: This retrospective cohort study aimed to determine the incidence of persistent perineal sinus (PPS) after proctectomy for Crohn disease (CD) and to identify associated risk factors. SUMMARY BACKGROUND DATA: Proctectomy remains necessary in a subset of patients with CD, yet impaired perineal wound healing and PPS continue to represent major sources of postoperative morbidity. METHODS: All patients undergoing proctectomy for CD between 1993 and 2023 at a tertiary referral center were included. The primary outcome was development of PPS, defined as a perineal wound remaining unhealed for ≥6 months after proctectomy. Associated risk factors were analyzed using regression analyses. RESULTS: Among 139 patients, 66.20% were women, and PPS occurred in 26. Healing was 81.30% (95% CI, 74.40%-87.30%) at 6 months and 93.50% (95% CI, 88.60%-96.80%) at 12 months; median healing time was 1.80 months (IQR, 0.90-4.60).Patients operated after 2011 (n=113, 81.30%) were significantly older, more ASA III, and active smokers, with longer disease duration, lower CRP, and higher number of advanced therapies.PPS was associated with younger age (OR 0.79; P=0.014) and omentoplasty (OR 2.60; P=0.036). After correction for year of surgery, only older age independently predicted faster healing (OR 0.90; 95% CI, 0.83-0.97; P=0.005), while ≥3 therapy lines showed a nonsignificant protective effect (OR 0.36; 95% CI, 0.12-1.07; P=0.067). CONCLUSION: Although PPS remains frequent after proctectomy for Crohn disease, most patients ultimately achieve perineal healing. Older age at surgery is the only independent predictor of faster healing. Improved control of systemic inflammation may reduce the risk of PPS.