Perianal fistulas in Crohn's disease - treatment results in a specialized multidisciplinary unit: LTP10

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Aim:About 1/3 of patients with Crohn's disease develops perianal fistulas. The current study was conducted to determinate outcomepredictors in patients treated by interdisciplinary approach.Method:Deep fistulas were treated by a fistulotomy. For high fistulas, a noncutting seton was placed followed by maintenance treatment with azathioprine and/or infliximab. An ‘non-optimal outcome’ was recorded when there was need for diverting stoma, and complete healing was not achieved by fistulotomy or symptoms of fistula were not under control, i.e. there was a need for treatment extension during the follow-up.Results:Sixty-six patients underwent 100 surgeries. The most frequent types of fistula were high transsphincteric (62%), and high intersphincteric (15%). At the end of the study, seven patients requiredproctectomy, symptoms of fistula were not under control in 12 patients, three patients required a diverting stoma. Altogether, 33% have not achieved an ‘optimal outcome’. Factors associated with ‘not-optimal outcome’ were: Crohn's colitis, age at the beginning of Crohn's disease < 20 years, types of fistula not suitable for fistulotomy, anterior fistula.Conclusions:Interdisciplinary approach will lead to a successful outcome in > 65% of patients. Presence of Crohn's colitis, young age at the beginning of the disease, and fistula anatomy areprognostic indicators.

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