Long-Term Outcome of Surgery for Perianal Crohn's Fistula.

Details

Serval ID
serval:BIB_AFD225280E30
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Long-Term Outcome of Surgery for Perianal Crohn's Fistula.
Journal
Medicina
Author(s)
Schaad M., Schoepfer A., Rossel J.B., Barry M.P., Rogler G., Hahnloser D.
Working group(s)
Swiss IBD Cohort Study Group
ISSN
1648-9144 (Electronic)
ISSN-L
1010-660X
Publication state
Published
Issued date
24/06/2024
Peer-reviewed
Oui
Volume
60
Number
7
Language
english
Notes
Publication types: Journal Article
Publication Status: epublish
Abstract
Background and Objectives: Patients with perianal Crohn's (CD) fistula often need repetitive surgeries and none of the established techniques was shown to be superior or preferable. Furthermore, the long-term outcome of fistula Seton drainage is not well described. The aims of this study were to analyze the long-term healing and recurrence rate of CD perianal fistulas in a large patient cohort. Materials and Methods: Database analysis of the Swiss IBD (Inflammatory Bowel Disease) cohort study. Results: 365 perianal fistula patients with 576 surgical interventions and a median follow-up of 7.5 years (0-12.6) were analyzed. 39.7% of patients required more than one procedure. The first surgical interventions were fistulectomies ± mucosal sliding flap (59.2%), Seton drainage (29.6%), fistula plugs or fibrin glue installations (2.5%) and combined procedures (8.8%). Fistulectomy patients required no more surgery in 69%, one additional surgery in 25% and more than one additional surgery in 6%, with closure rates at 7.5 years follow-up of 77.1%, 74.1% and 66.7%, respectively. In patients with Seton drainage as index surgery, 52% required no more surgery, and over 75% achieved fistula closure after 10 years. Conclusions: First-line fistulectomies, when feasible, achieved the highest healing rates, but one-third of patients required additional surgeries, and one-fourth of patients will remain with a fistula at 10 years. Initial Seton drainage and concurrent medical therapy can achieve fistula closure in 75%. However, in 50% of patients, more surgeries are needed, and fistula closure is achieved in only two-thirds of patients.
Keywords
Humans, Crohn Disease/surgery, Crohn Disease/complications, Male, Female, Rectal Fistula/surgery, Rectal Fistula/etiology, Adult, Treatment Outcome, Middle Aged, Cohort Studies, Drainage/methods, Switzerland, Recurrence, Aged, Crohn’s disease, Seton drainage, perianal fistula
Pubmed
Web of science
Open Access
Yes
Create date
05/08/2024 7:55
Last modification date
08/08/2024 6:28
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