Management of complex perianal Crohn’s disease

Abstract

Patients with Crohn’s disease often develop perianal disease, successfully managed in most cases. However, its most aggressive form, complex perianal disease, is associated with high morbidity and a significant impairment in patients’ quality of life. The aim of this review is to provide an updated approach to this condition, reviewing aspects of its epidemiology, diagnosis and therapeutic alternatives. Emerging treatment options are also discussed. A multidisciplinary assessment of these patients with a coordinated medical and surgical approach is crucial.

The role of multimodal treatment in Crohn′s disease patients with perianal fistula: a multicentre retrospective cohort study

“…Surgical intervention at presentation is indispensable for a majority of patients with CD‐pAF mainly for drainage of symptomatic abscesses and insertion of seton . The effectiveness of medical therapy is limited, since few RCTs have been conducted on patients with CD‐pAF with complete fistula closure (combining clinical evaluation + imaging confirmation) as the primary outcome . More recently, mesenchymal stem cell treatment has shown promising results compared to standard medical treatment; however, the fistula closure rates in those patients treated with placebo confirm that a good surgical approach plays a key role on the resolution of CD‐pAF.…”

“…9,13 The effectiveness of medical therapy is limited, since few RCTs have been conducted on patients with CD-pAF with complete fistula closure (combining clinical evaluation + imaging confirmation) as the primary outcome. 8,14 More recently, mesenchymal stem cell treatment has shown promising results compared to standard medical treatment; however, the fistula closure rates in those patients treated with placebo confirm that a good surgical approach plays a key T A B L E 2 Univariable and multivariable analysis of predictors of repeated surgery. Finally, the removal of seton and therapy with infliximab or adalimumab were associated to a significantly lower risk of repeated surgery in our study cohort role on the resolution of CD-pAF.…”

Treatment Algorithms for Crohn’s Disease

“…These complex fistulae are: high (high means involving > 2/3 of the external sphincter) intersphincteric, high transsphincteric, suprasphincteric, and extrasphincteric, may have multiple openings and may be associated with an abscess, proctitis, rectal stricture, or may be connected with the bladder or vagina [60]. Any anterior fistula in women is generally considered complex due to potential genital complications [61]. In contrast, simple fistulae are low fistulae that involve superficial tissue and include subcutaneous and intersphincteric and intrasphincteric fistulae that remain below the dentate line, have a single opening, and are not associated with perianal complications [60,61].…”

“…Any anterior fistula in women is generally considered complex due to potential genital complications [61]. In contrast, simple fistulae are low fistulae that involve superficial tissue and include subcutaneous and intersphincteric and intrasphincteric fistulae that remain below the dentate line, have a single opening, and are not associated with perianal complications [60,61].…”

Perianal Crohn's Disease in Children and Adolescents

“…Due to mixed result in adult studies, these treatment modalities are not currently recommended for children. 42 Endorectal mucosal advanced flap surgery in which a vascularized flap of rectal mucosa and submucosa is elevated, internal fistula opening is over sewn, and the flap is tacked down over the closure, may be considered in children with a single fistula source that is easily identified without active infection or rectal disease. 5 A success rate up to 50% has been reported in carefully selected adult patients.…”