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Management of perianal fistula in inflammatory bowel disease: identification of prognostic factors associated with surgery

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Abstract

Purpose

As one of the clinical manifestations of inflammatory bowel disease (IBD), perianal fistula disease (PFD) can potentially impact the patient quality of life. The management of PFD employs a multidisciplinary approach which includes antibiotics, biological therapies, immunomodulators, and surgery. We analyzed the outcome and prognostic factors of anal fistula surgery in IBD patients.

Methods

We conducted a retrospective study of IBD patients undergoing elective surgery for anal fistula between January 2015 and December 2018 at our University Department of Surgery. We collated demographic factors, disease activity, imaging (MRI and endoanal ultrasound), surgical interventions, and medical treatment assessing the rate of fistula closure and fecal incontinence, 2 months and 1 year after surgery.

Results

Thirty-five IBD patients with anal fistula underwent surgery (28 Crohn’s disease, four ulcerative colitis, and three indeterminate colitis). Twenty-seven patients presented with complex fistulas and eight with simple fistulas with 10 patients undergoing single-stage surgery. In 25 patients, a two-stage surgical approach was planned and performed (draining seton plus medical treatment and then second-stage surgery with curative intent). At 1 year of follow-up, the fistula healing rate was 50% for single-stage surgery and 60% for two-stage surgery (P = 0.09). Overall, 19.2% of patients developed postoperative fecal incontinence. A time interval greater than 12 months between surgeries is a favorable prognostic factor for fistula healing with the two-stage approach (P = 0.002).

Conclusions

In our retrospective study, two-stage surgery in IBD patients presenting with complex perianal fistulous disease results in a better medium-term outcome with a longer time interval between surgeries.

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Acknowledgements

The authors wish to thank the Biostatistics Department, Unidad de Bioestadística del Hospital Universitario La Paz, for its contribution and assistance with this work.

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Authors and Affiliations

  1. General Surgery Department, La Paz University Hospital, Paseo de la Castellana, 261 28046, Madrid, Spain

    Sara Gortázar de Las Casas, Mario Alvarez-Gallego, Jose Antonio Gazo Martínez, Natalia González Alcolea, Cristina Barragán Serrano, Aitor Urbieta Jiménez, Jose Luis Marijuan Martín & Isabel Pascual Migueláñez

  2. Gastroenterology Department, La Paz University Hospital, Madrid, Spain

    María Dolores Martín Arranz

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  1. Sara Gortázar de Las Casas
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Correspondence to Sara Gortázar de Las Casas.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained before surgery from all individual participants included in the study.

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The authors declare no competing interests.

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de Las Casas, S.G., Alvarez-Gallego, M., Martínez, J.A.G. et al. Management of perianal fistula in inflammatory bowel disease: identification of prognostic factors associated with surgery. Langenbecks Arch Surg 406, 1181–1188 (2021). https://doi.org/10.1007/s00423-021-02100-4

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