Incidence and clinical outcomes of intersphincteric abscesses diagnosed by anal ultrasonography in patients with crohnʼs disease

Viganò, Chiara; Losco, Alessandra; Caprioli, Flavio; Basilisco, Guido

doi:10.1002/ibd.21596

Cited by 15 publications

(14 citation statements)

References 24 publications

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“…Perianal fistulation is common in patients with Crohn's disease, the estimated lifetime risk of perianal fistula being between 14% and 38% in population‐based estimates . Perianal fistulizing disease is associated with local pain, discharge and considerable morbidity (including destruction of the sphincter and perineal tissue), resulting in a negative impact on quality of life . Unfortunately spontaneous fistula closure rates are low, with estimates ranging from 6% to 13% .…”

Section: Introductionmentioning

confidence: 99%

Treatment of perianal fistula in Crohn's disease: a systematic review and meta‐analysis comparing seton drainage and anti‐tumour necrosis factor treatment

et al. 2016

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Section: Introductionmentioning

confidence: 99%

Treatment of perianal fistula in Crohn's disease: a systematic review and meta‐analysis comparing seton drainage and anti‐tumour necrosis factor treatment

et al. 2016

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“…High perianal fistulas in patients with CD have an enormous impact on patients’ quality of life, as well as on health care systems [ 2 ]. Our goal is to provide evidence for optimal treatment resulting in (inter)national consensus of all disciplines involved in the treatment of these patients.…”

Section: Discussionmentioning

confidence: 99%

“…Crohn’s disease (CD) is a chronic disease that typically affects young adults, with a lifetime risk of fistula development ranging from 14 to 38 % in population-based estimates [ 1 ]. Perianal fistulising CD is associated with local pain, discharge and considerable morbidity rates (including sphincter and perineal tissue destruction), resulting in a negative impact on quality of life [ 2 ]. The impact on health care resources is enormous due to multiple surgical interventions and costly medication.…”

Section: Introductionmentioning

confidence: 99%

Multimodal treatment of perianal fistulas in Crohn’s disease: seton versus anti-TNF versus advancement plasty (PISA): study protocol for a randomized controlled trial

Groof

Buskens

Ponsioen

et al. 2015

Trials

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BackgroundCurrently there is no guideline for the treatment of patients with Crohn’s disease and high perianal fistulas. Most patients receive anti-TNF medication, but no long-term results of this expensive medication have been described, nor has its efficiency been compared to surgical strategies. With this study, we hope to provide treatment consensus for daily clinical practice with reduction in costs.Methods/DesignThis is a multicentre, randomized controlled trial. Patients with Crohn’s disease who are over 18 years of age, with newly diagnosed or recurrent active high perianal fistulas, with one internal opening and no anti-TNF usage in the past three months will be considered. Patients with proctitis, recto-vaginal fistulas or anal stenosis will be excluded. Prior to randomisation, an MRI and ileocolonoscopy are required. All treatment will start with seton placement and a course of antibiotics. Patients will then be randomised to: (1) chronic seton drainage (with oral 6-mercaptopurine (6MP)) for one year, (2) anti-TNF medication (with 6MP) for one year (seton removal after six weeks) or (3) advancement plasty after eight weeks of seton drainage (under four months anti-TNF and 6MP for one year). The primary outcome parameter is the number of patients needing fistula-related re-intervention(s). Secondary outcomes are the number of patients with closed fistulas (based on an evaluated MRI score) after 18 months, disease activity, quality of life and costs.DiscussionThe PISA trial is a multicentre, randomised controlled trial of patients with Crohn’s disease and high perianal fistulas. With the comparison of three generally accepted treatment strategies, we will be able to comment on the efficiency of the various treatment strategies, with respect to several long-term outcome parameters.Trial registrationNederlands Trial Register identifier: NTR4137 (registered on 23 August 2013).Electronic supplementary materialThe online version of this article (doi:10.1186/s13063-015-0831-x) contains supplementary material, which is available to authorized users.

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“…Fistula development in CD ranges from 14 to 38 % in population-based estimates and is associated with considerable morbidity rates resulting in a negative impact on quality of life [ 21 ]. In specific patients with severe perianal involvement, a transperineal completion proctectomy may be indicated as a last resort option.…”

Section: Crohn’s Diseasementioning

confidence: 99%

Single‐Port Surgery in Inflammatory Bowel Disease: A Review of Current Evidence

2016

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The majority of patients with Crohn’s disease and up to 35 % of patients with ulcerative colitis will ultimately require surgery during the course of their disease. Over the past few years, surgical techniques and experience in minimal invasive surgery have evolved resulting in single-incision laparoscopic surgery. The aim of this approach is to diminish the surgical trauma by reducing the number of incision sites. This review discusses the benefits and disadvantages of single-port surgery in various procedures in patients with inflammatory bowel disease (IBD). Short-term postoperative results, functional outcome, and costs available in the literature will be discussed. Single-port surgery in IBD has several benefits when compared to multi-port laparoscopic surgery. By using fewer incisions, a potential reduction of postoperative pain with less morphine use can be accomplished. In addition, accelerated postoperative recovery can result in a shorter hospital stay. Furthermore, a superior cosmesis can be reached with placement of the port at the future ostomy site or at the umbilicus. Literature on single-port surgery in IBD consists mainly of case series and a few matched case series. These studies demonstrated that single-port surgery seems to be a safe and feasible approach for the surgical treatment of IBD patients.

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Incidence and clinical outcomes of intersphincteric abscesses diagnosed by anal ultrasonography in patients with crohnʼs disease

Cited by 15 publications

References 24 publications

Treatment of perianal fistula in Crohn's disease: a systematic review and meta‐analysis comparing seton drainage and anti‐tumour necrosis factor treatment

Treatment of perianal fistula in Crohn's disease: a systematic review and meta‐analysis comparing seton drainage and anti‐tumour necrosis factor treatment

Multimodal treatment of perianal fistulas in Crohn’s disease: seton versus anti-TNF versus advancement plasty (PISA): study protocol for a randomized controlled trial

Single‐Port Surgery in Inflammatory Bowel Disease: A Review of Current Evidence

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