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Surgery: Perineum

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Book cover Crohn’s Disease

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Abstract

Perianal Crohn’s disease affects approximately 30 % of patients and may be manifested as skin tags, hemorrhoids, fissures, ulcerations, anorectal abscess with associated fistulas and strictures of the anorectal ring. Symptoms range from mild to disabling and in up to one-third of patients result in the need for fecal diversion and/or proctectomy. Improvements and refinements in radiologic imaging in particular with respect to endoanal ultrasonography and magnetic resonance imaging have improved assessment of the disease and assisted with surgical planning. Improvements in medical therapy particularly the use of biologics have improved the clinical course of patients with fistulous disease. Close coordination of care with the patient, gastroenterologist, and surgeon is essential. A number of options for fistulas including the LIFT procedure, fistula plugs, and advancement flaps have expanded the surgical options but all of these options have decreased efficacy in patients with Crohn’s disease. The chronic smoldering symptoms in patients with perianal disease make it challenging for the both the patient and the treating physician.

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Authors and Affiliations

  1. Department of Colon and Rectal Surgery, Division of Surgery, Lahey Hospital and Medical Center, 41 Mall Road, Burlington, MA, 01805, USA

    Patricia L. Roberts MD

  2. Tufts University School of Medicine, Boston, MA, USA

    Patricia L. Roberts MD

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  1. Patricia L. Roberts MD
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Correspondence to Patricia L. Roberts MD .

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Editors and Affiliations

  1. Department of Surgery, University of Washington Medical Center, Seattle, Washington, USA

    Alessandro Fichera

  2. Department of Surgery, University of Washington Medical Center, Seattle, Washington, USA

    Mukta K. Krane

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Roberts, P.L. (2015). Surgery: Perineum. In: Fichera, A., Krane, M. (eds) Crohn’s Disease. Springer, Cham. https://doi.org/10.1007/978-3-319-14181-7_13

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  • DOI: https://doi.org/10.1007/978-3-319-14181-7_13

  • Publisher Name: Springer, Cham

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