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
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
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