Advertisement

Management of Simple Anoperineal Fistulas

  • Chady Atallah
  • Matthew MutchEmail author
Chapter

Abstract

Patients with anoperineal Crohn’s disease (CD) are often challenging to treat. They frequently require a combination of medical and surgical treatment to control their disease. More than one-third of patients with Crohn’s disease will at some point develop perianal disease, and some patients will have it as their presenting symptom several years before a diagnosis of Crohn’s disease is made. Anal fistulas are particularly difficult to treat in patients with Crohn’s disease due to the pathophysiologic characteristics of the disease, the high likelihood of recurrence, and the potential for surgical complications.

References

  1. 1.
    Eglinton TW, Barclay ML, Gearry RB, et al. The spectrum of perianal Crohn’s disease in a population-based cohort. Dis Colon Rectum 2012;55(7):773-7.CrossRefGoogle Scholar
  2. 2.
    Tozer PJ, Lung P, Lobo AJ, et al. Review article: pathogenesis of Crohn’s perianal fistula-understanding factors impacting on success and failure of treatment strategies. Aliment Pharmacol Ther. 2018;48(3):260–9.CrossRefGoogle Scholar
  3. 3.
    Steele SR, Kumar R, Feingold DL, et al. Practice parameters for the management of perianal abscess and fistula-in-ano. Dis Colon Rectum. 2011;54(12):1465–74.CrossRefGoogle Scholar
  4. 4.
    Vogel JD, Johnson EK, Morris AM, et al. Clinical practice guideline for the management of anorectal abscess, fistula-in-ano, and rectovaginal fistula. Dis Colon Rectum. 2016;59(12):1117–33.CrossRefGoogle Scholar
  5. 5.
    Halme L, Sainio AP. Factors related to frequency, type, and outcome of anal fistulas in Crohn’s disease. Dis Colon Rectum. 1995;38(1):55–9.CrossRefGoogle Scholar
  6. 6.
    Scott HJ, Northover JM. Evaluation of surgery for perianal Crohn’s fistulas. Dis Colon Rectum. 1996;39(9):1039–43.CrossRefGoogle Scholar
  7. 7.
    Williamson PR, Hellinger MD, Larach SW, Ferrara A. Twenty-year review of the surgical management of perianal Crohn’s disease. Dis Colon Rectum. 1995;38(4):389–92.CrossRefGoogle Scholar
  8. 8.
    Sangwan YP, Schoetz DJ Jr, Murray JJ, et al. Perianal Crohn’s disease. Results of local surgical treatment. Dis Colon Rectum. 1996;39(5):529–35.CrossRefGoogle Scholar
  9. 9.
    Platell C, Mackay J, Collopy B, et al. Anal pathology in patients with Crohn’s disease. Aust N Z J Surg. 1996;66(1):5–9.CrossRefGoogle Scholar
  10. 10.
    Michelassi F, Melis M, Rubin M, Hurst RD. Surgical treatment of anorectal complications in Crohn’s disease. Surgery. 2000;128(4):597–603.CrossRefGoogle Scholar
  11. 11.
    van Koperen PJ, Safiruddin F, Bemelman WA, Slors JF. Outcome of surgical treatment for fistula in ano in Crohn’s disease. Br J Surg. 2009;96(6):675–9.CrossRefGoogle Scholar
  12. 12.
    Witte ME, Klaase JM, Gerritsen JJ, Kummer EW. Fibrin glue treatment for simple and complex anal fistulas. Hepatogastroenterology. 2007;54(76):1071–3.PubMedGoogle Scholar
  13. 13.
    Grimaud JC, Munoz-Bongrand N, Siproudhis L, et al. Fibrin glue is effective healing perianal fistulas in patients with Crohn’s disease. Gastroenterology. 2010;138(7):2275–81.CrossRefGoogle Scholar
  14. 14.
    Senéjoux A, Siproudhis L, Abramowitz L, et al. Fistula plug in fistulising ano-perineal Crohn’s disease: a randomised controlled trial. J Crohns Colitis. 2016;10(2):141–8.  https://doi.org/10.1093/ecco-jcc/jjv162.CrossRefPubMedGoogle Scholar
  15. 15.
    Lowry PW, Weaver AL, Tremaine WJ, Sandborn WJ. Combination therapy with oral tacrolimus (FK506) and azathioprine or 6-mercaptopurine for treatment-refractory Crohn’s disease perianal fistulae. Inflamm Bowel Dis. 1999;5(4):239–45.CrossRefGoogle Scholar
  16. 16.
    Thia KT, Mahadevan U, Feagan BG, et al. Ciprofloxacin or metronidazole for the treatment of perianal fistulas in patients with Crohn’s disease: a randomized, double-blind, placebo-controlled pilot study. Inflamm Bowel Dis. 2009;15(1):17–24.CrossRefGoogle Scholar
  17. 17.
    Topstad DR, Panaccione R, Heine JA, et al. Combined seton placement, infliximab infusion, and maintenance immunosuppressives improve healing rate in fistulizing anorectal Crohn’s disease: a single center experience. Dis Colon Rectum. 2003;46(5):577–83.CrossRefGoogle Scholar
  18. 18.
    Park EJ, Song KH, Baik SH, et al. The efficacy of infliximab combined with surgical treatment of fistulizing perianal Crohn’s disease: comparative analysis according to fistula subtypes. Asian J Surg. 2018;41(5):438–47.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Section of Colon and Rectal Surgery, Division of General Surgery, Department of SurgeryWashington University School of Medicine at Barnes Jewish HospitalSt. LouisUSA

Personalised recommendations