Treatment of complex perianal fistulas in Crohn disease: infliximab, surgery or combined approach

Background: The aim of this study was to compare the outcomes of the management of perianal fistulas in Crohn disease between infliximab, surgery or a combination of surgery and infliximab. Methods: We prospectively subdivided 35 consecutive patients with Crohn disease with complex perianal fistulas into 3 groups: 11 patients received infliximab (5 mg/kg intravenously at 0, 2 and 6 wk; group A), 10 underwent surgery (group B) and 14 received a combination of surgery and postoperative infliximab (group C). We evaluated the rate and time of healing of perianal fistulas, the rate of recurrences and time to relapse at a median follow-up of 18.8 (standard deviation [SD] 10.8, range 8-38) months. Results: The time to healing of fistulas was significantly shorter among patients who received surgery and infliximab than among those who received surgery alone (p < 0.05) and was close to statistically shorter among those who received both treatments than among those who received infliximab alone (p = 0.06). Patients who received surgery and infliximab had a significantly longer mean time to relapse (p < 0.05) than those who received infliximab (mean 2.6 [SD 0.7] mo) or surgery alone (mean 3.6 [SD 0.5] mo). Conclusion: We found better outcomes among patients who received a combination of surgery and infliximab therapy. These patients experienced a short time to healing of fistulas and significantly longer mean time to relapse of complex fistulas.