Treatment Strategy for Perianal Fistulas in Crohn Disease Patients: The Surgeon’s Point of View
Perianal fistula is a frequent complication and one of the subclassifications of Crohn disease (CD). It is the most commonly observed symptomatic condition by colorectal surgeons. Accurately classifying a perianal fistula is the initial step in its management in CD patients. Surgical management is s...
| Main Authors: | , , |
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| Format: | Article |
| Language: | English |
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Korean Society of Coloproctology
2021-02-01
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| Series: | Annals of Coloproctology |
| Subjects: | |
| Online Access: | http://coloproctol.org/upload/pdf/ac-2021-02-08.pdf |
| _version_ | 1819284635721400320 |
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| author | Jong Lyul Lee Yong Sik Yoon Chang Sik Yu |
| author_facet | Jong Lyul Lee Yong Sik Yoon Chang Sik Yu |
| author_sort | Jong Lyul Lee |
| collection | DOAJ |
| description | Perianal fistula is a frequent complication and one of the subclassifications of Crohn disease (CD). It is the most commonly observed symptomatic condition by colorectal surgeons. Accurately classifying a perianal fistula is the initial step in its management in CD patients. Surgical management is selected based on the type of perianal fistula and the presence of rectal inflammation; it includes fistulotomy, fistulectomy, seton procedure, fistula plug insertion, video-assisted ablation of the fistulous tract, stem cell therapy, and proctectomy with stoma creation. Perianal fistulas are also managed medically, such as antibiotics, immunomodulators, and biologics including anti-tumor necrosis factor-alpha agents. The current standard treatment of choice for perianal fistula in CD patients is the multidisciplinary approach combining surgical and medical management; however, the rate of long-term remission is low and is reported to be 50% at most. Therefore, the optimum management strategy for perianal fistulas associated with CD remains controversial. Currently, the goal of management for CD-related perianal fistulas are controlling symptoms and maintaining long-term anal function without proctectomy, while monitoring progression to anorectal carcinoma. This review evaluates perianal fistula in CD patients and determines the optimal surgical management strategy based on recent evidence. |
| first_indexed | 2024-12-24T01:50:31Z |
| format | Article |
| id | doaj.art-e566fc9bd226450a8ec0932dfbac44e7 |
| institution | Directory Open Access Journal |
| issn | 2287-9714 2287-9722 |
| language | English |
| last_indexed | 2024-12-24T01:50:31Z |
| publishDate | 2021-02-01 |
| publisher | Korean Society of Coloproctology |
| record_format | Article |
| series | Annals of Coloproctology |
| spelling | doaj.art-e566fc9bd226450a8ec0932dfbac44e72022-12-21T17:21:45ZengKorean Society of ColoproctologyAnnals of Coloproctology2287-97142287-97222021-02-0137151510.3393/ac.2021.02.081790Treatment Strategy for Perianal Fistulas in Crohn Disease Patients: The Surgeon’s Point of ViewJong Lyul Lee0Yong Sik Yoon1Chang Sik Yu Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, KoreaPerianal fistula is a frequent complication and one of the subclassifications of Crohn disease (CD). It is the most commonly observed symptomatic condition by colorectal surgeons. Accurately classifying a perianal fistula is the initial step in its management in CD patients. Surgical management is selected based on the type of perianal fistula and the presence of rectal inflammation; it includes fistulotomy, fistulectomy, seton procedure, fistula plug insertion, video-assisted ablation of the fistulous tract, stem cell therapy, and proctectomy with stoma creation. Perianal fistulas are also managed medically, such as antibiotics, immunomodulators, and biologics including anti-tumor necrosis factor-alpha agents. The current standard treatment of choice for perianal fistula in CD patients is the multidisciplinary approach combining surgical and medical management; however, the rate of long-term remission is low and is reported to be 50% at most. Therefore, the optimum management strategy for perianal fistulas associated with CD remains controversial. Currently, the goal of management for CD-related perianal fistulas are controlling symptoms and maintaining long-term anal function without proctectomy, while monitoring progression to anorectal carcinoma. This review evaluates perianal fistula in CD patients and determines the optimal surgical management strategy based on recent evidence.http://coloproctol.org/upload/pdf/ac-2021-02-08.pdfcrohn diseaseinflammatory bowel diseaseanal fistula |
| spellingShingle | Jong Lyul Lee Yong Sik Yoon Chang Sik Yu Treatment Strategy for Perianal Fistulas in Crohn Disease Patients: The Surgeon’s Point of View Annals of Coloproctology crohn disease inflammatory bowel disease anal fistula |
| title | Treatment Strategy for Perianal Fistulas in Crohn Disease Patients: The Surgeon’s Point of View |
| title_full | Treatment Strategy for Perianal Fistulas in Crohn Disease Patients: The Surgeon’s Point of View |
| title_fullStr | Treatment Strategy for Perianal Fistulas in Crohn Disease Patients: The Surgeon’s Point of View |
| title_full_unstemmed | Treatment Strategy for Perianal Fistulas in Crohn Disease Patients: The Surgeon’s Point of View |
| title_short | Treatment Strategy for Perianal Fistulas in Crohn Disease Patients: The Surgeon’s Point of View |
| title_sort | treatment strategy for perianal fistulas in crohn disease patients the surgeon s point of view |
| topic | crohn disease inflammatory bowel disease anal fistula |
| url | http://coloproctol.org/upload/pdf/ac-2021-02-08.pdf |
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