Intersphincteric proctectomy.

Conventional proctectomy for inflammatory bowel disease is followed by delayed perineal wound healing in 20% to 63% of patients and sexual dysfunction in up to 17%. Although described several times since 1967, intersphincteric proctectomy is a technique used by very few surgeons in the United States. Accurate and safe rectal mobilization is easily accomplished by dissection within the intersphincteric plane, resulting in minimal damage to the pelvic floor and pelvic nerves and a much smaller perineal wound. The records of 58 patients who underwent rectal excision were examined. Proctectomy was performed in a conventional fashion for 30 patients and an intersphincteric proctectomy was performed for 28 patients. Of the 30 conventional procedures, 20 were for ulcerative colitis and 10 were for Crohn's disease. There was complete healing of the perineal wound in 70% of the patients at 6 months and in 73% at 1 year. There were four residual deep sinus tracts. Of the 15 men, three developed impotence, one permanently. Of the 28 patients who underwent intersphincteric proctectomy, 17 had ulcerative colitis, eight had Crohn's disease, two had incapacitating proctitis, and one had cancer of the midrectum. There was complete healing of the perineal wound in 84% of the patients at 6 months and in 84% at 1 year. There were no residual deep sinus tracts. Of the 15 men, one developed impotence that resolved after 1 year. Only one patient complained of persistent anal discomfort. The morbidity rate from intersphincteric proctectomy is low and we recommend more widespread use of this technique.