Modern surgical strategies for perianal Crohn's disease

• Main Author: Zabot, Gilmara Pandolfo
• Publication Date: 2020
• Other Authors: Cassol, Ornella, Saad-Hossne, Rogerio [UNESP], Bemelman, Willem
• Format: Other
• Language: eng
• Source: Repositório Institucional da UNESP
• Download full: http://dx.doi.org/10.3748/wjg.v26.i42.6572; http://hdl.handle.net/11449/206924
• topic: Anorectal fistula; Crohn's disease; Inflammatory bowel disease; Perianal fistulas; Surgical treatment

One of the most challenging phenotypes of Crohn's disease is perianal fistulizing disease (PFCD). It occurs in up to 50% of the patients who also have symptoms in other parts of the gastrointestinal tract, and in 5% of the cases it occurs as the first manifestation. It is associated with severe symptoms, such as pain, fecal incontinence, and a significant reduction in quality of life. The presence of perianal disease in conjunction with Crohn's disease portends a significantly worse disease course. These patients require close monitoring to identify those at risk of worsening disease, suboptimal biological drug levels, and signs of developing neoplasm. The last 2 decades have seen significant advancements in the management of PFCD. More recently, newer biologics, cell-based therapies, and novel surgical techniques have been introduced in the hope of improved outcomes. However, in refractory cases, many patients face the decision of having a stoma made and/or a proctectomy performed. In this review, we describe modern surgical management and the most recent advances in the management of complex PFCD, which will likely impact clinical practice.