title: Association of Coloproctology of Great Britain and Ireland consensus exercise on surgical management of fistulating perianal Crohn's disease.
abstract: OBJECTIVE
  Management of fistulating perianal Crohn's disease (fpCD) is a significant challenge for a colorectal surgeon. A recent survey of surgical practice in this condition showed variation in management approaches. As a result we set out to devise recommendations for practice for UK colorectal surgeons.
  
  
  METHODS
  Results from a national survey were used to devise a set of potential consensus statements. Consultant colorectal surgeons were invited to participate in the exercise via the previous survey and the mailing list of the professional society. Iterative voting was performed on each statement using a five-point Likert scale and electronic voting, with opportunity for discussion and refinement between each vote. Consensus was defined as > 80% agreement.
  
  
  RESULTS
  Seventeen surgeons and two patient representatives voted upon 51 statements. Consensus was achieved on 39 items. Participants advocated a patient-centred approach by a colorectal specialist, within strong multidisciplinary teamworking. The use of anti-TNFα therapy is advocated. Where definitive surgical techniques are considered they should be carefully selected to avoid adverse impact on function. Ano/rectovaginal fistulas should be managed by specialists in fistulating disease. Stoma or proctectomy could be discussed earlier in a patient's treatment pathway to improve choice, as they may improve quality of life.
  
  
  CONCLUSIONS
  This consensus provides principles and guidance for best practice in managing patients with fpCD.
authors.affiliation: Department of Oncology and Metabolism, Medical School, University of Sheffield, Sheffield, UK.|Department of General Surgery, Sheffield Teaching Hospitals, Sheffield, UK.
authors.forename: M J
authors.identifier: http://orcid.org/0000-0001-9971-1635
authors.initials: MJ
authors.lastname: Lee
authors.affiliation: University Hospital South Manchester, Manchester, UK.
authors.forename: N
authors.initials: N
authors.lastname: Heywood
authors.affiliation: St James University Hospital, Leeds, UK.
authors.forename: P M
authors.initials: PM
authors.lastname: Sagar
authors.affiliation: Department of General Surgery, Sheffield Teaching Hospitals, Sheffield, UK.
authors.forename: S R
authors.initials: SR
authors.lastname: Brown
authors.affiliation: Addenbrooke's Hospital, Cambridge, UK.
authors.forename: N S
authors.initials: NS
authors.lastname: Fearnhead
mesh_terms: D003082:Colectomy / Q000379:methods / Q000592:standards*; D032921:Consensus; D003424:Crohn Disease / Q000150:complications / Q000601:surgery*; D005762:Gastroenterology / Q000458:organization & administration / Q000592:standards; D006801:Humans; D017410:Practice Guidelines as Topic / Q000592:standards*; D012003:Rectal Fistula / Q000209:etiology / Q000601:surgery*; D012955:Societies, Medical / Q000592:standards; D006113:United Kingdom
keywords: Crohn's disease; anal fistula; consensus; seton