Managing Complex Perianal Fistulizing Disease

Pedersen, Karina E; Lightner, Amy L.

doi:10.1089/lap.2021.0285

Cited by 2 publications

(3 citation statements)

References 70 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…This is in keeping with other studies, which emphasize drainage of any abscesses and maintenance of the fistula tract with a loose seton. 19,20,22 Other surgical techniques such as fistulotomy, mucosal advancement flap, ligation of an intersphincteric fistula tract, or cone-like resection are reserved for specific scenarios on a case-by-case basis, and our institutional practice echoes this evidence. 23,[37][38][39][40] In our study, 22% of patients required fecal diversion (for perianal disease or persistent Crohn's disease), and only 15% of these patients had continuity restored.…”

Section: Discussionmentioning

confidence: 95%

“…19 The historic healing rate of perianal fistulas in adult patients with Crohn's disease is 30%, but this rate is less clear in the pediatric population because of small sample sizes in prior case series. 10,11,20 In adults, first-line treatment includes surgical drainage of abscesses and control of fistula(s) with seton drains in combination with antibiotics, biologics, and immunomodulator therapies. [21][22][23][24] However, it is unclear whether the optimal strategy for perianal fistulas is the same for pediatric patients.…”

Section: Principales Medidas De Resultadomentioning

confidence: 99%

See 1 more Smart Citation

Long-term Outcomes of Perianal Fistulas in Pediatric Crohn’s Disease

Kurowski

Achkar

et al. 2023

Diseases of the Colon &Amp; Rectum

Self Cite

View full text Add to dashboard Cite

BACKGROUND: Approximately 30% of Crohn’s disease–related perianal fistulas heal in the adult population with conventional medical and surgical interventions. This healing rate remains unknown in pediatric patients. OBJECTIVE: This study aimed to determine the healing rate of pediatric perianal Crohn’s fistulas and identify factors associated with healing. DESIGN: Retrospective case series. SETTING: A quaternary referral center. PATIENTS: Patients aged <18 years with a Crohn’s perianal fistula, seen between January 1, 1991, and August 1, 2021, were included in the study. INTERVENTIONS: Multivariable logistic regression to identify factors independently associated with perianal fistula healing. MAIN OUTCOME MEASURES: Healing of Crohn’s perianal fistula at the date of last clinical encounter, defined as the clinical note reporting a healed fistula or normal perianal examination. RESULTS: A total of 91 patients aged <18 years with a Crohn’s disease–related perianal fistula were identified (59% female, 76% white). The mean (SD) age at Crohn’s diagnosis was 12 (±4) years. The mean follow-up after Crohn’s diagnosis was 10 (±7) years. Overall, 89% of patients had a perianal fistula, 2% had an anovaginal fistula, and 10% had an ileal pouch-associated fistula. Patients underwent a median (interquartile range) of 2 (1–5) operations. A seton was placed in 60% of patients, 47% underwent abscess drainage, and 44% underwent fistulotomy or fistulectomy. Fistula healing occurred in 71% of patients over a median of 1.3 (0.4–2.5) years. Seven patients (7%) underwent proctectomy, and 3 (3%) underwent ileal pouch excision. After multivariable adjustment, younger age at diagnosis of perianal fistula was associated with an increased likelihood of healing (OR 0.56 for each increased year; 95% CI, 0.34–0.92). LIMITATIONS: Retrospective, single institution. CONCLUSIONS: Over two-thirds of fistulas heal in pediatric Crohn’s disease patients with conventional surgical and medical intervention. Younger age at fistula development is associated with an increased likelihood of healing. See Video Abstract at http://links.lww.com/DCR/C185. RESULTADOS A LARGO PLAZO DE LAS FÍSTULAS PERIANALES EN LA ENFERMEDAD DE CROHN EN PACIENTES PEDIÁTRICOS ANTECEDENTES: Aproximadamente el 30% de las fístulas perianales relacionadas con la enfermedad de Crohn se curan en la población adulta con intervenciones médicas y quirúrgicas convencionales. Esta tasa de curación sigue siendo desconocida en pacientes pediátricos. OBJETIVO: Determinar la tasa de curación de las fístulas de Crohn perianales en población pediátrica e identificar los factores asociados con la curación. DISEÑO: Serie de casos retrospectiva. ESCENARIO: Un centro de referencia cuaternario. PACIENTES: Pacientes menores de 18 años con fístula(s) perianal(es) por enfermedad de Crohn, atendidos entre el 1 de enero de 1991 y el 1 de agosto de 2021. INTERVENCIONES: Regresión logística multivariable para identificar factores asociados de forma independiente con la cicatrización de la ...

show abstract

Section: Discussionmentioning

confidence: 95%

Section: Principales Medidas De Resultadomentioning

confidence: 99%

Long-term Outcomes of Perianal Fistulas in Pediatric Crohn’s Disease

Kurowski

Achkar

et al. 2023

Diseases of the Colon &Amp; Rectum

Self Cite

View full text Add to dashboard Cite

show abstract

“…Although current treatments for PFs include a range of medical and surgical options, managing this condition is difficult. Patients with complex PFs tend to have poor treatment outcomes or experience frequent relapses, and most interventions are ineffective in providing long-term healing[ 7 - 10 ]. Immunomodulators can have serious side effects.…”

Section: Introductionmentioning

confidence: 99%

Up-to-date meta-analysis of long-term evaluations of mesenchymal stem cell therapy for complex perianal fistula

Cheng,

Zhong,

Huang

et al. 2023

World J Stem Cells

View full text Add to dashboard Cite

The art of constructing an insightful literature review manuscript has witnessed an exemplar in the work of Oz et al (2023), wherein concept progression harmoniously merges with figures and tables. Reflecting on retrospective data science, it is evident that well-cited articles can wield a transformative influence on the Journal Citation Reports Impact Factor score, as exemplified by Robert Weinberg’s landmark on cancer (Hanahan and Weinberg, 2011). Here, we aim to spotlight a commendable contribution by Tuba Oz, Ajeet Kaushik, and Małgorzata Kujawska in this issue while pivoting towards identifying the hallmarks of a subpar literature review-elements that hinder rather than promote advancement. The hurdles and roadblocks encountered within subpar literature reviews are multifold. Anticipation of emerging trends, identification of challenges, and exploration of solutions remain conspicuously absent. Original Contributions fail to surface amidst the vast sea of pre-existing literature, with noticeable gaps amplified by the lack of illustrative figures and tables. The manuscript, at times, assumes a skeletal form, reflecting an attempt to accommodate an excess of references, leading to convoluted sentences laden with citations. In contrast, a potent solution lies in adopting a comprehensive approach. A nuanced and critical evaluation of sources can culminate in a robust discussion, surpassing the mere summarization of conclusions drawn by others. This approach, often dismissed, holds the potential to elevate clarity, coherence, and logical flow, ultimately inviting engaged readership and coveted citations. The critical necessity of integrating visionary insights is underscored and achieved through a rigorous analysis of pivotal concepts and innovative ideas. Examples can be harnessed to elucidate the application of these solutions. We advocate a paradigm shift, urging literature review writers to embrace the readers’ perspective. A literature review’s purpose extends beyond providing a comprehensive panorama; it should illuminate avenues for concept development within a specific field of interest. By achieving this balance, literature reviews stand to captivate a devoted readership, paving the way for manuscripts that are both widely read and frequently cited. The pathway forward requires a fusion of astute analysis and visionary insights, shaping the future of literature review composition.

show abstract

Managing Complex Perianal Fistulizing Disease

Cited by 2 publications

References 70 publications

Long-term Outcomes of Perianal Fistulas in Pediatric Crohn’s Disease

Long-term Outcomes of Perianal Fistulas in Pediatric Crohn’s Disease

Up-to-date meta-analysis of long-term evaluations of mesenchymal stem cell therapy for complex perianal fistula

Contact Info

Product

Resources

About