title: Surgical treatment of perianal fistulizing Crohn's disease: from lay-open to cell-based therapy--an overview.
abstract: BACKGROUND
  Perianal Crohn's disease (CD) can be challenging. Despite the high incidence of fistulizing CD, literature lacks clear guidelines. Several medical, surgical, and combined treatment modalities have been proposed, but evidences are scarce.
  
  
  METHODS
  We searched the literature to assess the facets of perianal CD, with particular focus on complex fistulae. Disease epidemiology, classification, diagnosis, activity scoring systems, and medical-surgical treatments were assessed.
  
  
  RESULTS
  Perianal fistulizing CD is common, frequently associated with upper gastrointestinal and colorectal CD. Complex fistulas often require repeated treatments. Continence is a major concern when dealing with repeated procedures. A prudent pathway is to resolve active sepsis and to limit damages, delaying a definitive treatment to the time when acute phase has been controlled. The improved diagnostic techniques allow better preoperative planning and are useful in monitoring the response to treatment. Besides newer devices, cell-based treatments are promising tools which have recently enriched the treatment portfolio. However, the need for proctectomy is still disturbingly high in CD patients with complex perianal fistulae.
  
  
  CONCLUSIONS
  Perianal CD can impair quality of life and lead to need for proctectomy. A staged approach is reasonable. Treatment success can be improved by multimodal treatment and collaborative management by experienced gastroenterologists and surgeons.
authors.affiliation: Unit of General Surgery, Second University of Naples, Piazza Miraglia 2, 80138 Naples, Italy.
authors.forename: Gianluca
authors.identifier: 0000-0002-8322-6421
authors.initials: G
authors.lastname: Pellino
authors.affiliation: Unit of General Surgery, Second University of Naples, Piazza Miraglia 2, 80138 Naples, Italy.
authors.forename: Francesco
authors.identifier: 0000-0003-0610-1956
authors.initials: F
authors.lastname: Selvaggi
mesh_terms: D064987:Cell- and Tissue-Based Therapy / Q000379:methods* / Q000706:statistics & numerical data; D003131:Combined Modality Therapy / Q000379:methods; D003424:Crohn Disease / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D006801:Humans; D016032:Randomized Controlled Trials as Topic / Q000379:methods; D012003:Rectal Fistula / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D016896:Treatment Outcome