Surgical innovations in the multidisciplinary treatment of Crohn’s disease

This thesis focuses on the surgical treatment of patients with Crohn’s disease.
Part I describes and evaluates multiple treatment methods of perianal fistulas in patients with Crohn’s disease, especially the ligation of the intersphincteric fistula tract procedure and the advancement flap procedure. Multiple clinical outcome parameters as well as radiological healing after these surgical closure procedures were evaluated. Furthermore, outcome parameters after short-term anti-TNF therapy combined with surgical closure were directly compared to medical therapy only as treatment of Crohn’s perianal fistulas in the PISA-II trial; a patient preference randomised controlled trial. Both 18 month and long-term outcomes are described. Also, fistula characteristics on MRI after surgical closure and the relationship between those characteristics to patients’ clinical outcomes were evaluated, and it was evaluated whether certain MRI features could be used to predict clinical outcome in patients after surgical closure.
Part II of this thesis focuses on multiple (new) surgical treatment strategies for different problems of Crohn’s disease. Important dilemmas for medically refractory or complex Crohn’s disease are discussed. Furthermore, a novel treatment method using the Semiflex Dome System, a catheter set for vacuum therapy of perianal abscesses and fistulas is described. Lastly, in order to make management of the complex problem of the chronically failing pouch more comprehensible and make results between different centres more comparable, a new classification system for the surgical treatment of the chronically failing ileo-anal pouch is suggested in this thesis.