Minor Sphincter Sparing Surgery for Successful Closure of Perianal Fistulas in Patients with Crohn’s Disease

Merten J, Eichelmann A, Mennigen R, Flammang I, Pascher A, Rijcken E

Forschungsartikel (Zeitschrift) | Peer reviewed

Zusammenfassung

The purpose of this study is to demonstrate that repetitive minor surgical procedures allow for a high rate of permanent closure of perianal fistulas in patients with Crohn's disease (CD). Patients with perianal fistulizing CD (PFCD) who underwent perianal surgery at the University Hospital of Muenster between 2003 and 2018 were assessed for fistula characteristics and surgical procedures. We included 45 patients (m:f = 28:17) with a mean age of 27 years at first fistula appearance. Of these, 49% suffered from a complex fistula. An average of 4.2 (1-14) procedures were performed, abscess incisions and fistula seton drainages included. Draining setons were left in place for 5 (1-54) months, until fistula closure. Final surgical techniques were fistulotomy (31.1%), seton removal with sustained biological therapy (26.7%), Anal Fistula Plug (AFP) (17.8%), Over-The Scope-Clip proctology (OTSC) (11.1%), and mucosa advancement flap (4.4%). In 8.9% of cases, the seton was kept as permanent therapy. The time from first to last surgery was 18 (0-182) months and the median follow-up time after the last surgery was 90 (15-200) months. The recurrence rate was 15.5% after 45 (17-111) months. Recurrent fistulas healed after another 1.86 (1-2) surgical re-interventions. The final success rate was 80%. Despite biological treatment, PFCD management remains challenging. However, by repeating minor surgical interventions over a prolonged period of time, high permanent healing rates can be achieved.

Details zur Publikation

FachzeitschriftJournal of Clinical Medicine (J Clin Med)
Jahrgang / Bandnr. / Volume2021, 10, 4721
StatusVeröffentlicht
Veröffentlichungsjahr2021
Sprache, in der die Publikation verfasst istEnglisch
DOI10.3390/jcm10204721
StichwörterCrohn’s disease; OTSC; anal fistula plug; complex fistula; perianal fistula; seton drainage

Autor*innen der Universität Münster

Merten, Jennifer
Klinik für Allgemein- und Viszeralchirurgie