[Perianal fistulas in Crohn's disease: treatment results at an interdisciplinary unit].
BACKGROUND
Approximately one third of patients with Crohn's disease develop perianal fistulas. This study was conducted to determinate outcome predictors in patients treated at a specialized multidisciplinary unit.


METHODS
Between May 2005 and May 2008, all patients with perianal Crohn's fistulas were treated by the same surgeon and a gastroenterologist specialized in managing patients with Crohn's disease. Deep fistulas were treated by fistulotomy. For high fistulas, a noncutting seton was placed followed by maintenance treatment with azathioprine and/or infliximab. "Optimal outcome" was recorded when (a) there was no need for diverting stoma, (b) complete healing was achieved by fistulotomy, or (c) fistula symptoms were under control, i.e. there was no need for treatment extension during follow-up.


RESULTS
Thirty-four male and 32 female patients underwent 100 surgical interventions. The most frequent types of fistula were high trans-sphincteric (62%) and high intersphincteric (15%). Eleven of the 32 females presented with rectovaginal fistulae. At the study end, complete healing was observed in 12 patients and 32 had good control of fistula symptoms. Seven required proctectomy, fistula symptoms were not under control in 12, and three required diverting stoma. Altogether 44 patients (67%) achieved optimal outcome. The following factors were predictors of nonoptimal outcome by multivariate analysis: presence of Crohn's colitis (P=0.01), age at the onset of Crohn's disease <20 years (P=0.02), and types of fistula not suitable for fistulotomy (P=0.05).


CONCLUSIONS
The multidisciplinary approach at specialized units will lead to successful outcome in >60% of patients with Crohn's perianal fistulas. The presence of Crohn's colitis, young age at disease onset, and presence of high fistulas are indicators of poor prognosis.
Iesalnieks
I
I
Klinik und Poliklinik für Chirurgie, Universitätsklinikum, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Deutschland. igors.iesalnieks@klinik.uni-regensburg.de
Glass
H
H
Kilger
A
A
Ott
C
C
Klebl
F
F
Agha
A
A
Schlitt
H J
HJ
Strauch
U
U
D000038:Abscess / Q000601:surgery; D000293:Adolescent; D000328:Adult; D000890:Anti-Infective Agents / Q000009:adverse effects; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage; D000911:Antibodies, Monoclonal / Q000008:administration & dosage; D001379:Azathioprine / Q000008:administration & dosage; D003424:Crohn Disease / Q000150:complications* / Q000601:surgery*; D004322:Drainage / Q000379:methods; D004359:Drug Therapy, Combination; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007081:Ileostomy; D007166:Immunosuppressive Agents / Q000008:administration & dosage; D000069285:Infliximab; D033183:Interdisciplinary Communication; D008297:Male; D008795:Metronidazole / Q000008:administration & dosage; D008875:Middle Aged; D010348:Patient Care Team; D011182:Postoperative Care; D011183:Postoperative Complications / Q000209:etiology / Q000601:surgery; D012003:Rectal Fistula / Q000145:classification / Q000601:surgery*; D012006:Rectovaginal Fistula / Q000145:classification / Q000601:surgery; D012007:Rectum / Q000601:surgery; D012086:Reoperation; D013524:Surgical Flaps; D016896:Treatment Outcome; D055815:Young Adult
D000890:Anti-Infective Agents; D000893:Anti-Inflammatory Agents; D000911:Antibodies, Monoclonal; D007166:Immunosuppressive Agents; D008795:Metronidazole; D000069285:Infliximab; D001379:Azathioprine