title: The role of surgery for children with perianal Crohn's disease.
abstract: OBJECTIVE
  Children with perianal Crohn's disease (PCD) are a unique and diverse patient population. The purpose of this study was to describe the spectrum of disease and role of surgery.
  
  
  METHODS
  A retrospective chart review of all children having at least one surgical intervention for PCD over 10 years was performed.
  
  
  RESULTS
  Fifty-seven patients (63% male) aged 0.5-17 (median 13) years were identified. Perianal disease consisted of skin tags (49%), superficial fistulae (49%), deep fistulae (37%), superficial abscesses (68%), deep abscesses (9%), skin breakdown (19%), and anal strictures (7%). 84% received anti-TNF therapy, with 27% treated with a second anti-TNF medication. Minor surgical procedures, commonly done during anti-TNF therapy, included abscess drainage (67%) and seton placement (33%). Major surgical procedures, done almost exclusively after anti-TNF failure, included defunctioning ileostomy (23%) and subtotal colectomy (9%). Follow-up ranged from 7 to 160 (median 54) months.
  
  
  CONCLUSIONS
  Pediatric PCD has a wide range of disease severity. Minor surgery provides adequate drainage before and during anti-TNF therapy, while major surgery plays a role in medically refractory disease. Appropriate surgical intervention remains an important part of the treatment paradigm.
authors.affiliation: Department of Surgery, University of Toronto, Toronto, ON, Canada; Institute of Medical Science, University of Toronto, Toronto, ON, Canada.
authors.forename: Natashia M
authors.initials: NM
authors.lastname: Seemann
authors.affiliation: Institute of Medical Science, University of Toronto, Toronto, ON, Canada; Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, The Hospital for Sick Children, Toronto, ON, Canada.
authors.forename: Abdul
authors.initials: A
authors.lastname: Elkadri
authors.affiliation: Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, The Hospital for Sick Children, Toronto, ON, Canada.
authors.forename: Thomas D
authors.initials: TD
authors.lastname: Walters
authors.affiliation: Department of Surgery, University of Toronto, Toronto, ON, Canada; Division of General and Thoracic Surgery, The Hospital for Sick Children, Toronto, ON, Canada. Electronic address: jacob.langer@sickkids.ca.
authors.forename: Jacob C
authors.initials: JC
authors.lastname: Langer
mesh_terms: D000038:Abscess / Q000150:complications* / Q000601:surgery; D000293:Adolescent; D001004:Anus Diseases / Q000150:complications*; D002648:Child; D002675:Child, Preschool; D003082:Colectomy; D003131:Combined Modality Therapy; D003424:Crohn Disease / Q000150:complications* / Q000188:drug therapy / Q000601:surgery*; D005260:Female; D006801:Humans; D007081:Ileostomy; D007223:Infant; D008297:Male; D010502:Perineum / Q000601:surgery; D012003:Rectal Fistula / Q000150:complications* / Q000601:surgery; D012189:Retrospective Studies; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors
chemical_list: D014409:Tumor Necrosis Factor-alpha
keywords: Crohn’s disease; Pediatric; Perianal; Surgery