Evaluation of surgery for perianal Crohn's fistulas

Scott, Humphrey; Northover, John

doi:10.1007/bf02054696

Cited by 87 publications

(67 citation statements)

References 15 publications

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“…In contrast, a complex fistula is located high (high transsphincteric, extrasphincteric or suprasphincteric), may be associated with pain, can potentially involve multiple external openings, and may be associated with rectovaginal fistula and/or anorectal stricture [6]. This is a clinically important differentiation, because several studies have shown better outcomes for patients with simple fistula tracts [7][8][9][10].…”

Section: Introductionmentioning

confidence: 99%

CARD15 Mutations and Perianal Fistulating Crohn’s Disease: Correlation and Predictive Value of Antibiotic Response

et al. 2010

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Background CARD15 mutations alter bowel immunity and increase susceptibility to Crohn 0 s disease (CD). However, the relation between these mutations and Crohn 0 s perianal fistulas has not been fully clarified. Aims To assess whether CARD15 mutations are associated with risk of developing Crohn's perianal fistulas and whether these mutations are predictors of the response of perianal fistulas to antibiotics. Methods CARD15 mutations were investigated in 203 consecutive CD patients. Presence/absence of history of perianal fistula was recorded. Patients with history of perianal fistula were divided into two groups (with/without CARD15 mutations), and response to antibiotics was evaluated in both groups. Results Of the 203 patients, 60 (29.6%) showed at least one CARD15 mutation and 55 (27.1%) had history of perianal fistula. History of perianal fistula was identified in 13 (21.7%) patients with mutations and in 42 (29.4%) patients without mutations (P = 0.260). Mean age at diagnosis of first perianal fistula was similar in patients with/without CARD15 mutations (28.7 ± 9.8 versus 29.7 ± 10.1 years, P = 0.758). Average time between disease onset and diagnosis of first perianal fistula was also similar in the two groups (4.6 ± 5.1 versus 5.0 ± 5.9 years, P = 0.816). Response of perianal fistulas to antibiotics (metronidazole alone or combined with ciprofloxacin) was significantly higher in patients without CARD15 mutations (7.7% versus 40.5%, P = 0.041). Conclusions In CD, CARD15 mutations are not associated with risk of developing perianal fistulas or with time of their outbreak. Nevertheless, patients with perianal fistulas and CARD15 mutations showed worse response to antibiotics.

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Section: Introductionmentioning

confidence: 99%

CARD15 Mutations and Perianal Fistulating Crohn’s Disease: Correlation and Predictive Value of Antibiotic Response

et al. 2010

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“…A summary of study characteristics is shown in Table 1, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43, 44, 45, 46, 47, 48, 49, 50, 51, 52, 53, 54, 55, 56, 57, 58, 59, 60, 61, 62, 63, 64, 65, 66, 67, 68, 69, 70, 71, 72, 73, 74, 75.…”

Section: Resultsmentioning

confidence: 99%

“…Occasional use of MRI to confirm fistula fibrosis was reported25. One study29 reported a successful outcome as ‘the patient and surgeon are both satisfied’. Only one study56 had blinded assessors – a panel of three surgeons who reviewed perineal photographs to confirm fistula closure.…”

Section: Resultsmentioning

confidence: 99%

“…Seven retrospective studies22 24, 27, 28, 29, 30 46 reported on the outcomes of fistulotomy in 148 patients. Although baseline factors were poorly reported, these were typically for low fistulas – those involving a small part of sphincter where division would not alter function.…”

Section: Resultsmentioning

confidence: 99%

“…Longer‐term (6 months or more after treatment) fistula recurrence occurred in five of 28 patients30 and three of nine patients46 at 12 months. One study29 found that 22 of 27 patients had a ‘satisfactory’ outcome, although the five patients in whom the outcome was unsuccessful developed significant incontinence. Higher rates of continence disturbance were seen in other studies30.…”

Section: Resultsmentioning

confidence: 99%

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Systematic review of surgical interventions for Crohn's anal fistula

Lee

Heywood²,

Adegbola

et al. 2017

BJS Open

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BackgroundAnal fistula occurs in approximately one in three patients with Crohn's disease and is typically managed through a multimodal approach. The optimal surgical therapy is not yet clear. The aim of this systematic review was to identify and assess the literature on surgical treatments of Crohn's anal fistula.MethodsA systematic review was conducted that analysed studies relating to surgical treatment of Crohn's anal fistula published on MEDLINE, Embase and Cochrane databases between January 1995 and March 2016. Studies reporting specific outcomes of patients treated for Crohn's anal fistula were included. The primary outcome was fistula healing rate. Bias was assessed using the Cochrane ROBINS‐I and ROB tool as appropriate.ResultsA total of 1628 citations were reviewed. Sixty‐three studies comprising 1584 patients were ultimately selected in the analyses. There was extensive reporting on the use of setons, advancement flaps and fistula plugs. Randomized trials were available only for stem cells and fistula plugs. There was inconsistency in outcome measures across studies, and a high degree of bias was noted.ConclusionData describing surgical intervention for Crohn's anal fistula are heterogeneous with a high degree of bias. There is a clear need for standardization of outcomes and description of study cohorts for better understanding of treatment options.

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