title: Medical and surgical treatment of haemorrhoids and anal fissure in Crohn's disease: a critical appraisal.
abstract: BACKGROUND
  The principle to avoid surgery for haemorrhoids and/or anal fissure in Crohn's disease (CD) patients is still currently valid despite advances in medical and surgical treatments. In this study we report our prospectively recorded data on medical and surgical treatment of haemorrhoids and anal fissures in CD patients over a period of 8 years.
  
  
  METHODS
  Clinical data of patients affected by perianal disease were routinely and prospectively inserted in a database between October 2003 and October 2011 at the Department of Surgery, Tor Vergata University Hospital, Rome. We reviewed and divided in two groups records on CD patients treated either medically or surgically according to the diagnosis of haemorrhoids or anal fissures. Moreover, we compared in each group the outcome in patients with prior diagnosis of CD and in patients diagnosed with CD only after perianal main treatment.
  
  
  RESULTS
  Eighty-six CD patients were included in the study; 45 were treated for haemorrhoids and 41 presented with anal fissure. Conservative approach was initially adopted for all patients; in case of medical treatment failure, the presence of stable intestinal disease made them eligible for surgery. Fifteen patients underwent haemorrhoidectomy (open 11; closed 3; stapled 1), and two rubber band ligation. Fourteen patients required surgery for anal fissure (Botox ± fissurectomy 8; LIS 6). In both groups we observed high complication rate, 41.2% for haemorrhoids and 57.1% for anal fissure. Patients who underwent haemorrhoidectomy without certain diagnosis of CD had significantly higher risk of complications.
  
  
  CONCLUSIONS
  Conservative treatment of proctologic diseases in CD patients has been advocated given the high risk of complications and the evidence that spontaneous healing may also occur. From these preliminary results a role of surgery is conceivable in high selected patients, but definitve conclusions can't be made. Further randomized trials are needed to establish the efficacy of the surgical approach, giving therapeutic recommendations and guidelines.
authors.affiliation: Department of Surgery, University Hospital Tor Vergata, Viale Oxford 81, Rome 00133, Italy. dugo.stefano@gmail.com
authors.forename: Stefano
authors.initials: S
authors.lastname: D'Ugo
authors.forename: Luana
authors.initials: L
authors.lastname: Franceschilli
authors.forename: Federica
authors.initials: F
authors.lastname: Cadeddu
authors.forename: Laura
authors.initials: L
authors.lastname: Leccesi
authors.forename: Giovanna Del Vecchio
authors.initials: Gdel V
authors.lastname: Blanco
authors.forename: Emma
authors.initials: E
authors.lastname: Calabrese
authors.forename: Giovanni
authors.initials: G
authors.lastname: Milito
authors.forename: Nicola
authors.initials: N
authors.lastname: Di Lorenzo
authors.forename: Achille L
authors.initials: AL
authors.lastname: Gaspari
authors.forename: Pierpaolo
authors.initials: P
authors.lastname: Sileri
mesh_terms: D000293:Adolescent; D000328:Adult; D003424:Crohn Disease / Q000150:complications*; D004358:Drug Therapy; D005260:Female; D005401:Fissure in Ano / Q000453:epidemiology / Q000209:etiology* / Q000628:therapy*; D005500:Follow-Up Studies; D061865:Hemorrhoidectomy; D006484:Hemorrhoids / Q000453:epidemiology / Q000209:etiology* / Q000628:therapy*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011351:Proctoscopy; D011446:Prospective Studies; D012189:Retrospective Studies; D017211:Treatment Failure; D016896:Treatment Outcome; D055815:Young Adult