title: Cone-like resection, fistulectomy and mucosal rectal sleeve partial endorectal pull-through in paediatric Crohn's disease with perianal complex fistula.
abstract: BACKGROUND
  Perianal abscesses and fistulae have been reported in approximately 15% of patients with paediatric Crohn's disease and they are associated with poor quality of life. Several surgical techniques were proposed for the treatment of perianal Crohn's disease, characterized by an elevated incidence of failure, incontinence, and relapse. Aim of our study was to present the technical details and results of our surgical technique in case of recurrent, persistent, complex perianal ano-rectal destroying Crohn's disease not responding to medical treatment.
  
  
  METHODS
  Data of patients who underwent surgical treatment (cone-like resection, fistulectomy, sphincter reconstruction, endorectal advancement sleeve flaps like in Soave endorectal pull-through) for complicated high-level trans, inter or suprasphincteric fistulae between January 2009 and June 2014 were retrospectively reviewed.
  
  
  RESULTS
  20 surgical procedures were performed in 11 patients (males 72.7%) with transsphincteric (n=5), intersphincteric (n=4) and suprasphincteric (n=2) fistulae. Three patients needed a second treatment. Two patients needed more than 2 surgeries and one temporary colostomy. No patient presented anal incontinence at 15 months' median follow-up.
  
  
  CONCLUSIONS
  Although several procedures may be required to obtain a complete remission of perianal lesions, in our series the proposed surgical technique seemed effective and safe, preserving anal continence in all treated cases and reducing the need of faecal diversion.
authors.affiliation: Giannina Gaslini Institute, Genoa, Italy; DINOGMI, University of Genoa, Italy. Electronic address: girolamomattioli@ospedale-gaslini.ge.it.
authors.forename: Girolamo
authors.initials: G
authors.lastname: Mattioli
authors.affiliation: Giannina Gaslini Institute, Genoa, Italy; DINOGMI, University of Genoa, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Pio
authors.affiliation: Giannina Gaslini Institute, Genoa, Italy.
authors.forename: Serena
authors.initials: S
authors.lastname: Arrigo
authors.affiliation: Giannina Gaslini Institute, Genoa, Italy.
authors.forename: Alessio
authors.initials: A
authors.lastname: Pini Prato
authors.affiliation: Giannina Gaslini Institute, Genoa, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Montobbio
authors.affiliation: Giannina Gaslini Institute, Genoa, Italy.
authors.forename: Nicola Massimo
authors.initials: NM
authors.lastname: Disma
authors.affiliation: Giannina Gaslini Institute, Genoa, Italy.
authors.forename: Arrigo
authors.initials: A
authors.lastname: Barabino
mesh_terms: D000038:Abscess / Q000209:etiology / Q000601:surgery*; D000293:Adolescent; D001003:Anal Canal / Q000601:surgery; D002648:Child; D002675:Child, Preschool; D003424:Crohn Disease / Q000150:complications / Q000188:drug therapy / Q000601:surgery*; D017577:Cutaneous Fistula / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D005260:Female; D006801:Humans; D007413:Intestinal Mucosa / Q000601:surgery; D008279:Magnetic Resonance Imaging; D008297:Male; D012003:Rectal Fistula / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D012007:Rectum / Q000601:surgery; D012008:Recurrence; D012086:Reoperation; D012189:Retrospective Studies; D055815:Young Adult
keywords: Complex fistula; Cone-like resection; Paediatric; Perianal Crohn's