Outcome of surgical treatment for fistula <i>in ano</i> in Crohn's disease

Koperen, Paul J. van; Safiruddin, Faiza; Bemelman, Willem A.; Slors, J. F. M.

doi:10.1002/bjs.6608

Cited by 84 publications

(50 citation statements)

References 20 publications

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“…One study29 found that 22 of 27 patients had a ‘satisfactory’ outcome, although the five patients in whom the outcome was unsuccessful developed significant incontinence. Higher rates of continence disturbance were seen in other studies30.…”

Section: Resultsmentioning

confidence: 41%

“…Longer‐term (6 months or more after treatment) fistula recurrence occurred in five of 28 patients30 and three of nine patients46 at 12 months. One study29 found that 22 of 27 patients had a ‘satisfactory’ outcome, although the five patients in whom the outcome was unsuccessful developed significant incontinence.…”

Section: Resultsmentioning

confidence: 98%

“…A summary of study characteristics is shown in Table 1, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43, 44, 45, 46, 47, 48, 49, 50, 51, 52, 53, 54, 55, 56, 57, 58, 59, 60, 61, 62, 63, 64, 65, 66, 67, 68, 69, 70, 71, 72, 73, 74, 75.…”

Section: Resultsmentioning

confidence: 99%

“…Seven retrospective studies22 24, 27, 28, 29, 30 46 reported on the outcomes of fistulotomy in 148 patients. Although baseline factors were poorly reported, these were typically for low fistulas – those involving a small part of sphincter where division would not alter function.…”

Section: Resultsmentioning

confidence: 99%

“…Eight retrospective30 37, 39 40, 42, 43, 44 46 and two prospective observational38 41 studies reported the outcome of mucosal advancement flaps in both Crohn's and cryptoglandular perianal fistulous disease. Of the 590 reported procedures, 204 were performed for Crohn's fistula.…”

Section: Resultsmentioning

confidence: 99%

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Systematic review of surgical interventions for Crohn's anal fistula

Lee

Heywood²,

Adegbola

et al. 2017

BJS Open

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BackgroundAnal fistula occurs in approximately one in three patients with Crohn's disease and is typically managed through a multimodal approach. The optimal surgical therapy is not yet clear. The aim of this systematic review was to identify and assess the literature on surgical treatments of Crohn's anal fistula.MethodsA systematic review was conducted that analysed studies relating to surgical treatment of Crohn's anal fistula published on MEDLINE, Embase and Cochrane databases between January 1995 and March 2016. Studies reporting specific outcomes of patients treated for Crohn's anal fistula were included. The primary outcome was fistula healing rate. Bias was assessed using the Cochrane ROBINS‐I and ROB tool as appropriate.ResultsA total of 1628 citations were reviewed. Sixty‐three studies comprising 1584 patients were ultimately selected in the analyses. There was extensive reporting on the use of setons, advancement flaps and fistula plugs. Randomized trials were available only for stem cells and fistula plugs. There was inconsistency in outcome measures across studies, and a high degree of bias was noted.ConclusionData describing surgical intervention for Crohn's anal fistula are heterogeneous with a high degree of bias. There is a clear need for standardization of outcomes and description of study cohorts for better understanding of treatment options.

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Section: Resultsmentioning

confidence: 41%

Section: Resultsmentioning

confidence: 98%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

See 3 more Smart Citations

Systematic review of surgical interventions for Crohn's anal fistula

Lee

Heywood²,

Adegbola

et al. 2017

BJS Open

View full text Add to dashboard Cite

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Systematic review and meta‐analysis of endorectal advancement flap and ligation of the intersphincteric fistula tract for cryptoglandular and Crohn's high perianal fistulas

et al. 2019

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Background High perianal fistulas require sphincter‐preserving surgery because of the risk of faecal incontinence. The ligation of the intersphincteric fistula tract (LIFT) procedure preserves anal sphincter function and is an alternative to the endorectal advancement flap (AF). The aim of this study was to evaluate outcomes of these procedures in patients with cryptoglandular and Crohn's perianal fistulas. Methods A systematic literature search was performed using MEDLINE, Embase and the Cochrane Library. All RCTs, cohort studies and case series (more than 5 patients) describing one or both techniques were included. Main outcomes were overall success rate, recurrence and incontinence following either technique. A proportional meta‐analysis was performed using a random‐effects model. Results Some 30 studies comprising 1295 patients were included (AF, 797; LIFT, 498). For cryptoglandular fistula (1098 patients), there was no significant difference between AF and LIFT for weighted overall success (74·6 (95 per cent c.i. 65·6 to 83·7) versus 69·1 (53·9 to 84·3) per cent respectively) and recurrence (25·6 (4·7 to 46·4) versus 21·9 (14·8 to 29·0) per cent) rates. For Crohn's perianal fistula (64 patients), no significant differences were observed between AF and LIFT for overall success rate (61 (45 to 76) versus 53 per cent respectively), but data on recurrence were limited. Incontinence rates were significantly higher after AF compared with LIFT (7·8 (3·3 to 12·4) versus 1·6 (0·4 to 2·8) per cent). Conclusion Overall success and recurrence rates were not significantly different between the AF and LIFT procedure, but continence was better preserved after LIFT.

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Systematic review with meta‐analysis: Safety and efficacy of local injections of mesenchymal stem cells in perianal fistulas

et al. 2019

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Perianal fistulas in Crohn's disease (CD) represent a highly debilitating and difficult‐to‐treat condition. Given emerging supportive evidence, we conducted a systematic review and meta‐analysis of all trials/observational studies to establish the safety and efficacy of local injections of mesenchymal stem cells (MSCs). The PRISMA‐P statement was applied for planning and reporting, and MEDLINE, EMBASE, Web of Science, Cochrane, CINAHL, ClinicalTrials.gov database, and ECCO 2017 proceedings were searched for published observational studies and one‐arm and randomized clinical trials (RCTs). Safety was assessed in terms of acute local/systemic events, long‐term events, and relatedness with MSC treatment. Efficacy was evaluated in terms of external and/or radiological closure of fistula tracks. After a review of 211 citations, 23 studies, including 696 participants, were evaluated. Four were RCTs with a total of 483 patients. Overall, fistula closure occurred in 80% of MSC‐treated patients. In RCTs, this rate was 64% in the MSC arm and 37% in the control arm (relative risk (RR) = 1.54). Radiological response occurred in 83% of MSC‐treated patients. Treatment‐related adverse events occurred in 1% of MSC‐treated patients, with severe treatment‐related adverse events reaching 0% over a median follow‐up of 6 months. In RCTs, treatment‐related adverse events occurred in 13% in the MSC arm and 24% in the control arm (RR = 0.65). The relapse rate was 0. These results suggest that a local MSC injection is safe and efficacious. Further clinical trials with standardized end‐points are required to ensure the timely implementation of this new therapy in the management of perianal CD.

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Outcome of surgical treatment for fistula in ano in Crohn's disease

Abstract: Surgical outcome for high or complex Crohn's fistula in ano remains disappointing, and recurrence is unpredictable.

Cited by 84 publications

References 20 publications

Systematic review of surgical interventions for Crohn's anal fistula

Systematic review of surgical interventions for Crohn's anal fistula

Systematic review and meta‐analysis of endorectal advancement flap and ligation of the intersphincteric fistula tract for cryptoglandular and Crohn's high perianal fistulas

Systematic review with meta‐analysis: Safety and efficacy of local injections of mesenchymal stem cells in perianal fistulas

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