Treatment Algorithms in the Case of Perianal Complications of Crohn's Disease

Aim: To construct an algorithm of the treatment tactics which would include modern conservative and surgical methods. Materials and Methods: Endoscopy under anesthesia, endorectal ultrasonography, histological and radiological examinations, MRT. In the last 22 years, 310 patients with Crohn's disease (CD) have been treated in our clinic of which 144 had perianal complications (60 fissure, 52 fistula, 61 perianal abscess). Results: The treatment of perianal abscesses is opening and drainage, followed by conservative treatment (local and systemic). Using conservative treatment for patients with fissure, clinical remission was attained in 45 (75%); another 15 patients (25%) were operated using Maslyak's method. We have not conducted surgical treatment of fissures for the last 5 years. 51 patients with fistulas were operated on. When the malignization was confirmed, we conducted extirpation of the rectum or coloproctectomy. Recurrence of CD was observed in 65 patients (45.1%) during the first 2 years after the beginning treatment and in 128 patients (88.9%) during 5 years. CDAI varied from 150 to 450. PCDAI was in the range of 5-20. Conclusions: (1) Planned surgical treatment of perianal complications requires complex examination of the gastrointestinal tract; (2) pararectal fistulas should be operated in the period of complete remission; (3) surgical treatment of perianal complications should be microinvasive, using non-cutting seton, fistulotomy and advancement flap, and (4) coloproctectomy is the final stage of treatment of perianal CD in severe cases. Copyright (C) 2009 S. Karger AG, Basel