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Introduction: Perianal disease occurs in up to 34% of inflammatory bowel disease (IBD) patients. An estimated 25% of women will become pregnant after the initial diagnosis, thus introducing the dilemma of whether mode of delivery affects perianal disease. The aim of our study was to analyze whether a cesarean section (C-section) or vaginal delivery influence perianal involvement. We hypothesized the delivery route would not alter post-partum perianal manifestations in the setting of previously healed perianal disease. Methods: All consecutive eligible IBD female patients between 1997 and 2022 who delivered were included. Prior perianal involvement, perianal flare after delivery and delivery method were noted. Results: We identified 190 patients with IBD who had a total of 322 deliveries; 169 (52%) were vaginal and 153 (48%) were by C-section. Nineteen women (10%) experienced 21/322 (6%) post-partum perianal flares. Independent predictors were previous abdominal surgery for IBD (OR, 2.7; 95% CI, 1–7.2; p = 0.042), ileocolonic involvement (OR, 3.3; 95% CI, 1.1–9.4; p = 0.030), previous perianal disease (OR, 22; 95% CI, 7–69; p < 0.001), active perianal disease (OR, 96; 95% CI, 21–446; p < 0.001) and biologic (OR, 4.4; 95% CI,1.4–13.6; p < 0.011) or antibiotic (OR, 19.6; 95% CI, 7–54; p < 0.001) treatment. Negative association was found for vaginal delivery (OR, 0.19; 95% CI, 0.06–0.61; p < 0.005). Number of post-partum flares was higher in the C-section group [17 (11%) vs. 4 (2%), p = 0.002]. Conclusions: Delivery by C-section section was not protective of ongoing perianal disease activity post-delivery, but should be recommended for women with active perianal involvement. Key messages: What is already known? Standard recommendations are vaginal delivery in patients with mild or quiescent perianal inflammatory bowel disease and C-section only in women with active perianal disease. However, in many other clinical situations, such as prior or inactive perianal disease, no guidelines are currently available. What is new here? Comparative study on perianal involvement and the delivery method in inflammatory bowel disease patients treated in a world reference center with extensive experience. What is new here? Providing knowledge for the standardization of the delivery method in patients with Inflammatory Bowel Disease and perianal involvement. Brief summary: Comparative study on perianal involvement and delivery method in inflammatory bowel disease patients treated at a world-reference center, concluding cesarean section doesn't protect from ongoing disease activity post-delivery, but it should be recommended for women with active involvement. [ABSTRACT FROM AUTHOR]

Peri-pouch fistulas are similar to Crohn's perianal fistulas except that, instead of the rectum containing the internal opening of the fistula, the internal opening is in the ileal pouch, constructed in place of the rectum. Unfortunately, reconstructive pouch surgery or trans-anal repairs of fistula tracts are often not offered to patients due to complications associated with poor wound healing and ongoing pouch dysfunction. Adult allogeneic bone-marrow-derived mesenchymal stem cells for the treatment of anovaginal and perianal fistulas in the setting of Crohn's like phenotype of the ileal pouch-anal anastomosis - a video vignette. [Extracted from the article]