Tu1824 Fistula Tract Transposition for Extrasphincteric Perianal Fistulae in Crohn's Disease

Burden and outcomes for complex perianal fistulas in Crohn’s disease: Systematic review

“… Rates of treatment failure and relapse or recurrence among Crohn’s disease patients with complex perianal fistula 1 . 1 For studies with mixed populations ( i.e ., patients with any fistula and those with complex fistula), only results for patients with Crohn’s disease and complex perianal fistulas were considered; 2 Defined as lack of or inadequate response to therapy ( i.e ., lack of complete response or lack of healing response); 3 Most studies (10 of 12) reported outcomes for surgical procedures that were considered major procedures in this review, ligation of intersphincteric fistula tract, advancement flap repair, mucosal advancement flap with injection of platelet-rich plasma into the fistula tract, myocutaneous flaps and proctocolectomy with permanent ileostomy, gracilis muscle transposition, over-the-scope-clip proctology, fistula tract transposition or standard surgical management (including both major and minor procedures)[ 34 - 36 , 42 , 48 - 50 , 53 , 54 , 66 ]. One study reported outcomes with permanent seton (minor procedure; other minor procedures reported in studies mentioned above included biologic fistula plug, and fibrin glue)[ 52 ].…”

“…In an Austrian retrospective cohort study, all five patients who underwent myocutaneous flaps and proctocolectomy with permanent ileostomy experienced healing at 3 mo, although one patient relapsed at 6 mo[ 35 ]. Similarly, in a retrospective Brazilian study, at a median follow-up of 15.2 mo, 1 of 5 patients who underwent fistula tract transposition experienced a recurrence associated with a new tract formation[ 36 ].…”

“…Few studies ( n = 11) reported patients’ continence after surgical procedures, and in most of these studies no negative effect on continence was observed[ 27 , 34 , 36 , 46 , 47 , 49 - 54 ]. In addition, the need for colostomy or ileostomy after treatment failure generally was not consistently reported across studies.…”