Anal Fistulas in Severe Perineal Crohn’s Disease: Mri Assessment in the Determination of Long-Term Healing Rates

Brochard, Charlène; Landemaine, Amandine; l'Héritier, A. Merlini; Dewitte, Marie; Tchoundjeu, Belinda; Rohou, Tanguy; Garros, Aurélien; Bouguen, Guillaume; Siproudhis, L.

doi:10.1093/ibd/izy055

Cited by 8 publications

(6 citation statements)

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“…Importantly, anatomical features of the anal fistula, including anterior fistula and supralevator extension, had a negative impact on the outcome of perianal fistulizing CD. These data are in line with previous studies [20]. Some anatomical features of fistula can be modified by surgical drainage techniques and lowering of the tract.…”

Section: Discussionsupporting

confidence: 92%

Combined strategies following surgical drainage for perianal fistulizing Crohn's disease: failure rates and prognostic factors

et al. 2020

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Aim The medico‐surgical strategy for the treatment of perianal fistulizing Crohn's disease (CD) following surgical drainage remains challenging and debated. Our aims were to describe the failure rate of therapeutic interventions after drainage of the fistula tract and determine the factors associated with failure to optimize medico‐surgical strategies. Method All consecutive patients with perianal fistulizing CD who underwent surgical drainage with at least a 12‐week follow‐up were included. Failure was defined as the occurrence of at least one of the following items: abscess recurrence, purulent discharge from the tract, visible external opening and further drainage procedure(s). Results One hundred and sixty‐nine patients were included. The median follow‐up was 4.0 years. The cumulative failure rates were 20%, 30% and 36% at 1, 3 and 5 years, respectively. The cumulative failure rates in patients who had sphincter‐sparing surgeries or seton removal were significantly higher than in those who had a fistulotomy. Anterior fistula [hazard ratio (HR) = 2.52 (1.13–5.61), P = 0.024], supralevator extension [HR = 20.78 (3.38–127.80), P = 0.001] and the absence or discontinuation of immunosuppressants after anal drainage [HR = 3.74 (1.11–12.5), P = 0.032] were significantly associated with failure in the multivariate analysis model. Conclusion Combined strategies for perianal fistulizing CD lead to a failure rate of 36% at 5 years. Where advisable, fistulotomy may be preferred because it has a lower rate of recurrence. The benefits of immunosuppressants require a dedicated prospective randomized trial.

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Section: Discussionsupporting

confidence: 92%

Combined strategies following surgical drainage for perianal fistulizing Crohn's disease: failure rates and prognostic factors

et al. 2020

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“…Randomized control trials have been carried out on the combined use of biologicals and surgical closure, but success rates have been difficult to assess because it has been difficult to determine the contribution of each procedure . In a recent study surgical closure of the tract was shown to improve healing rates better than treatment with biologicals or thiopurines . However, half of the patients with perianal fistulizing CD relapsed within 5 years of discontinuation of anti‐TNFα .…”

Section: Discussionmentioning

confidence: 99%

Sphincter‐sparing surgery for complex anal fistulas: radiofrequency thermocoagulation of the tract is of no help

et al. 2019

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Aim To compare the rate of failure of radiofrequency thermocoagulation for anal fistula with that of rectal advancement flap in a case‐matched study. Method Patients who underwent radiofrequency treatment were compared with age‐ and sex‐matched patients with Crohn's disease (CD) who underwent a rectal flap procedure. Fistula features, general characteristics and the main clinical events were recorded in a prospective database. Failure was defined by at least one of following: abscess, purulent discharge, visible external opening or further drainage procedure. Results A total of 62 patients [median age 45 (range 36.8–57.5) years; 22 women, 40 men; 22 with CD] were analysed. The failure rate of radiofrequency treatment was higher than that of rectal flap treatment (74.2% vs 32.2%; P = 0.004). The cumulative probabilities of failure of the radiofrequency treatment were 53.8% (38.8–68.3), 71.8% (55.3–84.0) and 87.4% (70.6–95.3) at 3, 6 and 12 months, respectively. Three patients in the radiofrequency group required drainage for an abscess and one had severe thermal ulceration. The Cox proportional hazards regression model (surgical procedure, obesity, CD) showed rectal flap treatment [3.48 (1.60–8.07); P = 0.001] and CD [2.60 (1.16–6.41); P = 0.02] to be the main independent predictors of healing. Conclusion Radiofrequency thermocoagulation is a less satisfactory sphincter‐sparing treatment for the management of anal fistula than a rectal flap procedure.

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“…Importantly, MRI assessment was performed at referral and at months 6, 12 and 24 which allowed assessment of the evolution of the fistula tract activity. It has been shown that MRI assessment of the fistula tract is necessary to optimize therapeutic management [30]. According to MRI, fistula tract healing was observed in 46.6% at 12 months and in 61.4% at 24 months.…”

Section: Discussionmentioning

confidence: 99%

Surgical closure, mainly with glue injection and anti‐tumour necrosis factor α, in fistulizing perianal Crohn's disease: A multicentre randomized controlled trial

et al. 2021

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Aim:In patients with fistulizing perianal Crohn's disease (CD), the need for a secondary surgical step is not defined. The aim was to assess the efficacy of surgical closure compared to a single seton removal in patients with drained fistulizing perianal CD treated with adalimumab.Methods: This was a multicentre, randomized controlled trial, comparing seton removal + surgical closure (closure group) to seton removal alone (control group) with a stratification according to the American Gastroenterological Association classification.The primary end-point was fistula closure at month 12 defined by the association of the following criteria: no seton, absence of a visible external opening, absence of discharge from the tract after finger compression, absence of an internal opening, absence of perianal pain/abscess and absence of fistula-related abnormalities.

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Anal Fistulas in Severe Perineal Crohn’s Disease: Mri Assessment in the Determination of Long-Term Healing Rates

Abstract: Therapeutic strategies for perianal fistulizing CD require robust anatomical and healing evaluations. Combined strategies using biologics to improve both drainage and secondary closure of the fistula tracts merit further study.

Cited by 8 publications

References 20 publications

Combined strategies following surgical drainage for perianal fistulizing Crohn's disease: failure rates and prognostic factors

Combined strategies following surgical drainage for perianal fistulizing Crohn's disease: failure rates and prognostic factors

Sphincter‐sparing surgery for complex anal fistulas: radiofrequency thermocoagulation of the tract is of no help

Surgical closure, mainly with glue injection and anti‐tumour necrosis factor α, in fistulizing perianal Crohn's disease: A multicentre randomized controlled trial

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