Twenty-year review of the surgical management of perianal Crohn's disease

Williamson, Paul; Hellinger, Michael D.; Larach, Sergio W.; Ferrara, Andrea

doi:10.1007/bf02054227

Cited by 104 publications

(56 citation statements)

References 12 publications

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“…As only 50% of patients respond to this therapy, predictors for selection of patients for antibiotic treatment are crucial [12][13][14][15][16]. This is even more relevant if we remember that inadequate treatment of perianal fistula may lead to fistula recurrence or can result in the fistula progressing from simple to complex form [17].…”

Section: Discussionmentioning

confidence: 99%

“…However, the response rate of perianal fistulas to antibiotics is only around 50% [12][13][14][15][16]. Furthermore, ineffective or inappropriate treatment of perianal fistula may lead to recurrence of the fistula or can result in the fistula progressing from simple to complex form [17]. Complex fistulas are more difficult to treat, have decreased healing rates, and are associated with less successful outcomes [7][8][9][10].…”

Section: Introductionmentioning

confidence: 99%

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CARD15 Mutations and Perianal Fistulating Crohn’s Disease: Correlation and Predictive Value of Antibiotic Response

et al. 2010

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Background CARD15 mutations alter bowel immunity and increase susceptibility to Crohn 0 s disease (CD). However, the relation between these mutations and Crohn 0 s perianal fistulas has not been fully clarified. Aims To assess whether CARD15 mutations are associated with risk of developing Crohn's perianal fistulas and whether these mutations are predictors of the response of perianal fistulas to antibiotics. Methods CARD15 mutations were investigated in 203 consecutive CD patients. Presence/absence of history of perianal fistula was recorded. Patients with history of perianal fistula were divided into two groups (with/without CARD15 mutations), and response to antibiotics was evaluated in both groups. Results Of the 203 patients, 60 (29.6%) showed at least one CARD15 mutation and 55 (27.1%) had history of perianal fistula. History of perianal fistula was identified in 13 (21.7%) patients with mutations and in 42 (29.4%) patients without mutations (P = 0.260). Mean age at diagnosis of first perianal fistula was similar in patients with/without CARD15 mutations (28.7 ± 9.8 versus 29.7 ± 10.1 years, P = 0.758). Average time between disease onset and diagnosis of first perianal fistula was also similar in the two groups (4.6 ± 5.1 versus 5.0 ± 5.9 years, P = 0.816). Response of perianal fistulas to antibiotics (metronidazole alone or combined with ciprofloxacin) was significantly higher in patients without CARD15 mutations (7.7% versus 40.5%, P = 0.041). Conclusions In CD, CARD15 mutations are not associated with risk of developing perianal fistulas or with time of their outbreak. Nevertheless, patients with perianal fistulas and CARD15 mutations showed worse response to antibiotics.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

CARD15 Mutations and Perianal Fistulating Crohn’s Disease: Correlation and Predictive Value of Antibiotic Response

et al. 2010

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“…In the literature around 10%20% of the patients with Crohn's disease will eventually require proctectomy [54,55] .…”

Section: Transperineal Completion Proctectomymentioning

confidence: 99%

Minimally invasive surgery for inflammatory bowel disease: Review of current developments and future perspectives

Neumann¹,

Rijcken²

2016

WJGPT

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“…Keighley et al previously reported a 54% prevalence of perianal disease in their cohort [29]. Other small studies of perianal CD report fistula repair and abscess drainages to be the commonest form surgery performed [30,31]. Reported proctectomy rates from referral centre studies vary between 9% and 38% [28,30].…”

Section: Findings In Relation To Other Studiesmentioning

confidence: 99%

Emerging trends and risk factors for perianal surgery in Crohn’s disease: a 20-year national population-based cohort study

Chhaya

Saxena

Cecil

et al. 2016

European Journal of Gastroenterology &Amp; Hepatology

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IntroductionLittle is known about rates of perianal surgery (PAS) in Crohn's disease (CD). Our aim was to determine trends in PAS, the timing of surgery relative to diagnosis of CD and to identify subgroups at risk of PAS. MethodsWe identified 9391 incident cases of CD between 1989-2009. We defined 3 era: era 1 (1989-1995), era 2 (1996-2002), era 3 (2003-2009) and determined trends in procedure type and the time to first PAS relative to the date of diagnosis. We used Kaplan-Meier analysis to demonstrate the rate of first PAS and performed Cox regression to determine subgroups at risk of PAS. ResultsAmong the 9391 incident cases of CD, 405 (4.3%) underwent PAS. The overall rate of PAS was 5.5% (95% CI: 4.9 -6.2%) 10 years after diagnosis. 34% (n=137) of all patients undergoing PAS had surgery in the 5 years before CD diagnosis. Abscess drainage increased from 34% to 58% whilst proctectomy decreased from 16% to 6% between era 1 and 3 respectively. Men (HR 1.51, 95% CI:1.24-1.84), those aged 17-40 years (HR 1.69, 95% CI: 1.09-2.02 vs those aged >40 years) and those with a history of previous intestinal resection (HR: 28.5, 95% CI: 22.2-36.5) were more likely to have PAS. ConclusionAround a third of patients have a PAS 5 years preceding their diagnosis of CD. Surgical practice has changed over twenty years with a decrease in proctectomy and a concurrent increase in abscess drainage. PAS should alert clinicians to consider a possible underlying diagnosis of CD.

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Twenty-year review of the surgical management of perianal Crohn's disease

Abstract: Early aggressive surgical management of suppurative complications of perianal Crohn's disease before complex management problems ensue results in a high incidence of healing and a low risk of subsequent proctectomy.

Cited by 104 publications

References 12 publications

CARD15 Mutations and Perianal Fistulating Crohn’s Disease: Correlation and Predictive Value of Antibiotic Response

CARD15 Mutations and Perianal Fistulating Crohn’s Disease: Correlation and Predictive Value of Antibiotic Response

Minimally invasive surgery for inflammatory bowel disease: Review of current developments and future perspectives

Emerging trends and risk factors for perianal surgery in Crohn’s disease: a 20-year national population-based cohort study

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