TY - JOUR
T1 - Modern surgical strategies for perianal Crohn's disease
AU - Zabot, Gilmara Pandolfo
AU - Cassol, Ornella
AU - Saad-Hossne, Rogerio
AU - Bemelman, Willem
PY - 2020/11/14
Y1 - 2020/11/14
N2 - 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.
AB - 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.
KW - Anorectal fistula
KW - Crohn's disease
KW - Inflammatory bowel disease
KW - Perianal fistulas
KW - Surgical treatment
UR - http://www.scopus.com/inward/record.url?scp=85097124993&partnerID=8YFLogxK
U2 - https://doi.org/10.3748/wjg.v26.i42.6572
DO - https://doi.org/10.3748/wjg.v26.i42.6572
M3 - Review article
C2 - 33268947
SN - 1007-9327
VL - 26
SP - 6572
EP - 6581
JO - World journal of gastroenterology
JF - World journal of gastroenterology
IS - 42
ER -