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To evaluate the efficacy and duration of response to infliximab in the management of complex perianal fistulas in Crohn's disease.Details of all patients commencing infliximab for complex peri-anal fistulas were collectedprospectively. Patients routinely underwent MR imaging and EUA before treatment. A complete responsewas defined as complete closure of the fistula with no further drainage on gentle fingerpressure. A partial response was defined as reduction in fistula size, number of fistulas, fistula drainage or fistula pain.Fifty-two patients (25 male, median age 24 years, range 5-72). were treated with infliximab for complex perianal Crohn's-related fistulas; The patients had received treatment for Crohn's disease for a median of 66 months (range 7-324 months). At a median follow up of 44 months (12-120) 22 patients (42.3%) had a complete response to treatment with 13 having no relapse and eight relapsing (five off treatment); 23 (44.2%) had a partial response with 10 patients responding to subsequent surgicalprocedures. Seven patients(13.5%) had no response.The response rates of complex perianal fistulae to infliximab are good. Partial response may be augmented by subsequent surgical treatment.