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Long-Term Outcome of Surgery for Perianal Crohn’s Fistula

Authors :
Marie Schaad
Alain Schoepfer
Jean-Benoît Rossel
Mamadou Pathé Barry
Gerhard Rogler
Dieter Hahnloser
Source :
Medicina, Vol 60, Iss 7, p 1035 (2024)
Publication Year :
2024
Publisher :
MDPI AG, 2024.

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.

Details

Language :
English
ISSN :
16489144 and 1010660X
Volume :
60
Issue :
7
Database :
Directory of Open Access Journals
Journal :
Medicina
Publication Type :
Academic Journal
Accession number :
edsdoj.815ca7a6b8148429b767ef41d4f1293
Document Type :
article
Full Text :
https://doi.org/10.3390/medicina60071035