A Multi-Disciplinary Approach to Perianal Fistulizing Crohn's Disease

Wiseman, Jacob J; Chawla, Tanya; Morin, Frédéric; Overstraeten, Anthony de Buck van; Weizman, Adam V.

doi:10.1055/s-0041-1740038

Cited by 8 publications

(5 citation statements)

References 44 publications

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“…In addition, the incidence of anorectal cancer in CD may be higher in Asia than in Western countries 35 . Therefore, patients with longstanding disease who have chronic non‐healing fistula, increase in bloody discharge, or increasing perianal pain should undergo examination under anesthesia with biopsy and curettage of the fistula track as well as close endoscopic and radiographic surveillance 36 …”

Section: Temporal Trend Of CD Surgical Rate Indications and Methodsmentioning

confidence: 99%

Perioperative optimization of Crohn's disease

Lin

Chen

et al. 2022

Annals of Gastroent Surgery

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Crohn's disease (CD) is a chronic inflammatory disease mainly affecting the gastrointestinal tract. With the increased availability of modalities in the last two decades, the treatment of CD has advanced remarkably. Although medical treatment is the mainstay of therapy, most patients require surgery during the course of their illness, especially those who experience complications. Nutritional optimization and ERAS implementation are crucial for patients with CD who require surgical intervention to reduce postoperative complications. The increased surgical risk was found to be associated with the use of corticosteroids, but the association of surgical risk with immunomodulators, biologic therapy, such as anti‐TNF mediations, anti‐integrin medications, and anti‐IL 12/23 was low in certainty. Decisions about preoperative medication must be made on an individual case‐dependent basis. Preoperative imaging studies can assist in the planning of appropriate surgical strategies and approaches. However, patients must be informed of any alterations to their treatment. In summary, the management of perioperative medications and surgery‐related decision‐making should be individualized and patient‐centered based on a multidisciplinary approach.

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Section: Temporal Trend Of CD Surgical Rate Indications and Methodsmentioning

confidence: 99%

Perioperative optimization of Crohn's disease

Lin

Chen

et al. 2022

Annals of Gastroent Surgery

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“…The risk of cancer in the rectal region as well as cancer of the distal rectum and anus in patients with perineal CD is increased. Patients should be treated (as has been emphasized elsewhere) multidisciplinary by a team of experts[ 52 ]. Examination under general anesthesia continues to be an important part of the diagnostic effort and subsequent therapeutic interventions.…”

Section: Colorectal Cancer and Dysplasia In Patients With Ibdmentioning

confidence: 99%

Surgical treatment of inflammatory bowel disease: From the gastroenterologist’s stand-point

Triantafillidis

2024

World J Gastrointest Surg

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Treatment of ulcerative colitis (UC) and Crohn’s disease (CD) represents, in the majority of cases, a real challenge to the gastroenterologist’s abilities and skills as well as a clinical test concerning his/her levels of medical knowledge and experience. During the last two decades, our pharmaceutical arsenal was significantly strengthened, especially after the introduction of the so-called biological agents, drugs which to a large extent not only improved the results of conservative treatment but also changed the natural history of the disease. However, colectomy is still necessary for some patients with severe UC although smaller compared to the past, precisely because of the improvements achieved in the available conservative treatment. Nevertheless, surgeries to treat colon dysplasia and cancer are increasing to some extent. At the same time, satisfactory improvements in surgical techniques, the pre-and post-operative care of patients, as well as the selection of the appropriate time for performing the surgery have been noticed. Regarding patients with CD, the improvement of conservative treatment did not significantly change the need for surgical treatment since two-thirds of patients need to undergo surgery at some point in the course of their disease. On the other hand, the outcome of the operation has improved through good preoperative care as well as the wide application of more conservative surgical techniques aimed at keeping as much of the bowel in situ as possible. This article discusses the indications for surgical management of UC patients from the gastroenterologist’s point of view, the results of the emerging new techniques such as transanal surgery and robotics, as well as alternative operations to the classic ileo-anal-pouch anastomosis. The author also discusses the basic principles of surgical management of patients with CD based on the results of the relevant literature. The self-evident is emphasized, that is, to achieve an excellent therapeutic result in patients with severe inflammatory bowel disease in today’s era; the close cooperation of gastroenterologists with surgeons, pathologists, imaging, and nutritionists is of paramount importance.

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“…Clinical evaluation, imaging, and examination under anaesthesia (EUA) are essential for diagnosis. EUA by an experienced surgeon is 90% accurate for detecting and classifying perianal fistulas and abscesses [9,10]. Pelvic MRI remains the gold standard in perianal CD [9,11].…”

Section: Introductionmentioning

confidence: 99%

“…Pelvic MRI remains the gold standard in perianal CD [9,11]. Alternatives include endoanal ultrasound, which is useful but less accurate than MRI [10], and transperineal ultrasound, a non-invasive, cost-effective option with comparable accuracy to MRI. Combining two imaging modalities enhances accuracy to nearly 100% [8,12].…”

Section: Introductionmentioning

confidence: 99%

Long-Term Outcome of Surgery for Perianal Crohn’s Fistula

Schaad,

Schoepfer,

Rossel

et al. 2024

Medicina

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Background and Objectives: Patients with perianal Crohn’s (CD) fistula often need repetitive surgeries and none of the established techniques was shown to be superior or preferable. Furthermore, the long-term outcome of fistula Seton drainage is not well described. The aims of this study were to analyze the long-term healing and recurrence rate of CD perianal fistulas in a large patient cohort. Materials and Methods: Database analysis of the Swiss IBD (Inflammatory Bowel Disease) cohort study. Results: 365 perianal fistula patients with 576 surgical interventions and a median follow-up of 7.5 years (0–12.6) were analyzed. 39.7% of patients required more than one procedure. The first surgical interventions were fistulectomies ± mucosal sliding flap (59.2%), Seton drainage (29.6%), fistula plugs or fibrin glue installations (2.5%) and combined procedures (8.8%). Fistulectomy patients required no more surgery in 69%, one additional surgery in 25% and more than one additional surgery in 6%, with closure rates at 7.5 years follow-up of 77.1%, 74.1% and 66.7%, respectively. In patients with Seton drainage as index surgery, 52% required no more surgery, and over 75% achieved fistula closure after 10 years. Conclusions: First-line fistulectomies, when feasible, achieved the highest healing rates, but one-third of patients required additional surgeries, and one-fourth of patients will remain with a fistula at 10 years. Initial Seton drainage and concurrent medical therapy can achieve fistula closure in 75%. However, in 50% of patients, more surgeries are needed, and fistula closure is achieved in only two-thirds of patients.

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A Multi-Disciplinary Approach to Perianal Fistulizing Crohn's Disease

Cited by 8 publications

References 44 publications

Perioperative optimization of Crohn's disease

Perioperative optimization of Crohn's disease

Surgical treatment of inflammatory bowel disease: From the gastroenterologist’s stand-point

Long-Term Outcome of Surgery for Perianal Crohn’s Fistula

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