Anorectal Function after Wide Local Excision of the Perianal Skin and Anal Squamous Epithelium in Patients with Perianal Paget's Disease

Mikimasa Ishikawa, Ryuichi Mibu and Masao Tanaka

Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University

Background: Wide local excision of the perianal skin and anal squamous epithelium is often used to treat perianal Paget's disease, but the effect of this procedure on anorectal functions has not been sufficiently studied. Objective: We clarified changes in anorectal function after wide local excision of the perianal skin. Subjects: Subjects were 9 patients with perianal Paget's disease. Methods: We distributed questionnaires on bowel habits and anorectal manometric studies before and after surgery. Results: Five of the 9 suffered from postoperative fecal incontinence. Four of these 5 had stenosis and/or deformity of the anus caused by local perianal complications such as infection and necrosis of implanted skin. Postoperative incontinence occurred only in patients with postoperative perianal complications. No differences were noted between pre- and post operative manometric results. No differences were seen between manometric values in those with and without postoperative perianal complications or with and without postoperative incontinence. Conclusion: Wide local excision of the perianal skin and anal squamous epithelium did not affect anorectal function. Postoperative incontinence may be due to anal configuration deformity following perianal complications. Prevention of local postoperative complications such as infection and necrosis of the implanted skin thus is important for maintaining fecal continence.

Key words
anus, extramammary Paget's disease, anorectal manometry, fecal incontinence

Reprint requests
Mikimasa Ishikawa Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University
3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582 JAPAN

Accepted
September 26, 2007

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