Background: The management of perianal Crohn's disease (CD) fistula represents a significant challenge. We aimed to conduct a meta-analysis to evaluating the efficacy and safety of combined surgical and anti-TNFs treatment compared with either single therapy in fistulising perianal CD.
Methods: MEDLINE, EMBASE and the Cochrane database were searched. The primary outcome was the number of patients who developed fistula closure as defined by the primary studies.
Results: Eight studies (3 prospective studies and 5 retrospective studies) invoving 688 patients were included. The rate of fistula closure of the combination therapy (78.5%, 197/251) was not significant higher compared with the surgical therapy alone (65.2%, 215/330) (OR 2.21, 95% CI 0.83–5.90, p=0.11). Similarly, neither the rate of complete closure nor the rate of partial closure was significantly different between the two groups. Significant lower proportion of patients in the combination group developed fistula recurrence (20.8%, 11/53) compared with the single surgical group (76.1%, 35/46) (OR 0.13, 95% CI 0.03–0.58; p=0.007). No significant difference observed between the combination therapy and anti-TNF therapy alone in the rate of fistula closure. However, the combination therapy was associated with a 76% risk reduction of fistula recurrence (OR 0.24, 95% CI 0.06–0.93, p=0.04, n=57). The adverse events were mostly related to anti-TNFs infusion.
Conclusions: Combined surgical and anti-TNFs therapy did not significant improve the fistula closure than the surgery or anti-TNFs therapy alone. However, it is superior to either therapy in preventing fistula recurrence of fistulising perianal CD without causing more adverse events.