Treatment of complex perianal fistulas in Crohn disease: infliximab, surgery or combined approach.
BACKGROUND
The aim of this study was to compare the outcomes of the management of perianal fistulas in Crohn disease between infliximab, surgery or a combination of surgery and infliximab.


METHODS
We prospectively subdivided 35 consecutive patients with Crohn disease with complex perianal fistulas into 3 groups: 11 patients received infliximab (5 mg/kg intravenously at 0, 2 and 6 wk; group A), 10 underwent surgery (group B) and 14 received a combination of surgery and postoperative infliximab (group C). We evaluated the rate and time of healing of perianal fistulas, the rate of recurrences and time to relapse at a median follow-up of 18.8 (standard deviation [SD] 10.8, range 8-38) months.


RESULTS
The time to healing of fistulas was significantly shorter among patients who received surgery and infliximab than among those who received surgery alone (p < 0.05) and was close to statistically shorter among those who received both treatments than among those who received infliximab alone (p = 0.06). Patients who received surgery and infliximab had a significantly longer mean time to relapse (p < 0.05) than those who received infliximab (mean 2.6 [SD 0.7] mo) or surgery alone (mean 3.6 [SD 0.5] mo).


CONCLUSIONS
We found better outcomes among patients who received a combination of surgery and infliximab therapy. These patients experienced a short time to healing of fistulas and significantly longer mean time to relapse of complex fistulas.
Sciaudone
Guido
G
Division of General Surgery, Second University of Naples, Naples, Italy.
Di Stazio
Crescenzo
C
Limongelli
Paolo
P
Guadagni
Ilaria
I
Pellino
Gianluca
G
Riegler
Gabriele
G
Coscione
Paolo
P
Selvaggi
Francesco
F
D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D003131:Combined Modality Therapy; D003424:Crohn Disease / Q000150:complications*; D003475:Curettage; D004322:Drainage; D005260:Female; D005500:Follow-Up Studies; D005765:Gastrointestinal Agents / Q000627:therapeutic use*; D006801:Humans; D000069285:Infliximab; D008297:Male; D011446:Prospective Studies; D012003:Rectal Fistula / Q000209:etiology / Q000628:therapy*; D012008:Recurrence; D013997:Time Factors; D014945:Wound Healing
D000911:Antibodies, Monoclonal; D005765:Gastrointestinal Agents; D000069285:Infliximab