Abstract Background Abdominoperineal resection (APR) with a permanent stoma is a last-resort treatment for inflammatory bowel disease (IBD). Despite complete removal of perineal digestive tissue, some patients develop persistent perineal suppurations. This study aimed to describe IBD patients presenting with chronic perineal suppurations after APR. Methods A retrospective multicentre study was conducted across four tertiary centres in France. Patients who underwent APR between 2014 and 2024 for active IBD or IBD-associated rectal/anal cancer were included. Those without clinical follow-up at 1, 6 and 12 months were excluded. The primary endpoint was the proportion of patients with persistent perineal suppurations at 12 months. Secondary endpoints were healing rates, need for advanced IBD therapy after APR and median healing time. Logistic regression identified predictors of chronic suppurations. Results Of 115 eligible patients, 103 were included (Table 1). Median age at surgery was 47 years, and 58.3% were female. Crohn’s disease accounted for 78.6% of cases. APR indications were active perineal disease (31.1%), ileal pouch dysfunction (20.4%), active luminal disease (18.4%), combined luminal and perineal disease (17.5%) and rectal/anal cancer (11.7%). Median disease duration was 20 years, and 61.2% had failed ≥2 advanced therapies. Median postoperative follow-up was 3.8 years. Healing rates were 55.3% at M1, 72.8% at M6 and 79.6% at M12 (Figure 1). Median healing time was 3 months. Twenty-one patients (20.4%) had persistent perineal suppurations at M12; among them, 15 (71.4%) did not achieve healing by the end of follow-up. Thirty-eight patients (36.9%) required advanced therapy after APR: 16.5% preventively, 15.5% for postoperative luminal or perineal recurrence, and 4.9% for extra-intestinal manifestations. Seven patients (6.8%) received advanced therapy specifically for chronic suppurations, with only two (28.6%) achieving perineal healing at one year. In univariate analysis, female sex (OR = 5.7; 95%CI 1.8–25.7; p = 0.003) and hidradenitis suppurativa at surgery (OR = 13.5; 95%CI 1.63–282; p = 0.02) were associated with chronic suppurations at 12 months. In multivariate analysis, only female sex remained significant (aOR=4.88; 95%CI 1.47–22.2; p = 0.008). Conclusion Most IBD patients undergoing APR with a permanent stoma achieve perineal healing within one year, but almost 20% develop persistent perineal suppurations. Female sex and hidradenitis suppurativa appear to increase this risk. These results suggest that IBD may relapse as a complex dermatologic form or as a deep fistulizing phenotype, even after complete amputation of the anal canal. Conflict of interest: Dr. Grellier, Nathan: Nathan Grellier received hospitality, registration fee support, and participation agreements for events from Norgine, Celltrion Healthcare, Takeda, and Lilly. Mclellan, Paul: No conflict of interest Challine, Alexandre: No conflict of interest Spaes, Ylang: No conflict of interest Maggiori, Léon: No conflict of interest Kirchgesner, Julien: Lecture fees and/or consulting fees from from Abbvie, Amgen, Astrazeneca, Celltrion, Galapagos, Janssen, Lilly, MSD, Takeda, Tillots, Pfizer. Bresteau, Clément: No conflict of interest Draullette, Mélanie: No conflict of interest Amiot, Aurelien: Personal Fees: Abbvie, Fresenius-Kabi, Adacyte, Tillotts pharma, Janssen, Pfizer, Biogen, AMgen, Sandoz, Takeda, Galapagos, Eli Lilly Uzzan, Mathieu: Grant: ECCO-IOIBD, Fondation pour la Recherche Medicale (FRM), SNFGE Personal Fees: Abbvie, Takeda, Celltrion, Janssen, Amgen, Alfasigma, Pfizer Bourrier, Anne: No conflict of interest Debove, Clotilde: No conflict of interest Bazin, Thomas: No conflict of interest Panis, Yves: No conflict of interest Meyer, Antoine: No conflict of interest Nuzzo, Alexandre: No conflict of interest Chafai, Najim: No conflict of interest Carbonnel, Franck: No conflict of interest Nion-Larmurier, Isabelle: No conflict of interest Sokol, Harry: - Consulting : Amgen, Fresenius, IPSEN, Actial, Astellas, Danone, THAC, Biose, BiomX, Eligo, Immusmol, Adare, Nestle, Ferring - Conference : Amgen, MSD, Ferring, Bledina, Astellas, Pfizer, Biocodex, BMS, Bromatech, Ferring, Fresenius, Gieal, Janssen, Mayoli, Roche, Sanofi, Servier, Takeda, Abbvie - stocks : Enterome bioscience - co-founder of Exeliom Biosciences Parc, Yann: No conflict of interest Lefevre, Jeremie: Personal Fees: Takeda, SafeHeal, Biomup, Intuitive Seksik, Philippe: I received personal fees from Takeda, Janssen, Merck MSD, Biocodex, Ferring, Fresenius Kabi, Astellas, Amgen, Pfizer, Pilege and Abbvie
Grellier et al. (Thu,) studied this question.