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Perianal Surgery in Crohn’s Disease

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Crohn’s Disease

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Abstract

The perianal Crohn’s disease present a variety of perianal lesions. The short term goal of therapy is the resolution of sepsis. The long term goals are the resolution of lesions, preserving continence and avoiding proctectomy with stoma. The main lesion is the perianal fistula. In the complex fistula the best results are obteinig by combination of surgical and medical therapies. Many surgical thecniques are aimed at closing the fistula. We describe these thecniques and report their results.

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Bibliography

  1. Hughes LE. Clinical classification of perianal Crohn’s disease. Dis Colon Rectum. 1992;35:928–32.

    Article  CAS  PubMed  Google Scholar 

  2. Sandborn JW, Fazio WV, Feagan GB, Hanauer BC, American Gastroenterological Association Clinical Practice Committee. AGA technical review on perianal Crohn’s disease. Gastroenterology. 2003;125:1508–30.

    Article  PubMed  Google Scholar 

  3. American Gastroenterological Association Clinical Practice Committee. American gastroenterological association medical position statement: perianal Crohn’s disease. Gastroenterology. 2003;125:1503–7.

    Article  Google Scholar 

  4. Bell SJ, Williams AB, Wiesel P, Wilkinson K, Cohen RC, Kamm MA. The clinical course of fistulating Crohn’s disease. Aliment Pharmacol Ther. 2003;17:1145–51.

    Article  CAS  PubMed  Google Scholar 

  5. Caprilli R, Gassull MA, Escher JC, Moser G, Munkholm P, Forbes A, Hommes DW, Lochs H, Angelucci E, Cocco A, Vucelic B, Hildebrand H, Kolacek S, Riis L, Lukas M, de Franchis R, Hamilton M, Jantschek G, Michetti P, O’Morain C, Anwar MM, Freitas JL, Mouzas IA, Baert F, Mitchell R, Hawkey CJ, European Crohn’s and Colitis Organisation (ECCO). European evidence based consensus on the diagnosis and management of Crohn’s disease: special situations. Gut. 2006;55(Supplement 1):i36–58.

    Article  PubMed Central  PubMed  Google Scholar 

  6. Gecse KB, Bemelman W, Kamm MA, Stoker J, Khanna R, Ng SC, Panés J, van Assche G, Liu Z, Hart A, Levesque BG, D’Haens G, World Gastroenterology Organization, International Organisation for Inflammatory Bowel Diseases IOIBD, European Society of Coloproctology and Robarts Clinical Trials. A global consensus on the classification, diagnosis and multidisciplinary treatment of perianal fistulising Crohn’s disease. Gut. 2014;63:1381–92.

    Article  PubMed  Google Scholar 

  7. Orlando A, Armuzzi A, Papi C, Annese V, Ardizzone S, Biancone L, Bortoli A, Castiglione F, D’Incà R, Gionchetti P, Kohn A, Poggioli G, Rizzello F, Vecchi M, Cottone M. The Italian Society of Gastroenterology (SIGE) and the Italian Group for the study of Inflammatory Bowel Disease(IG-IBD) Clinical Practice Guidelines: the use of tumor necrosis factor-alpha antagonist therapy in inflammatory bowel disease. Dig Liver Dis. 2011;43(1):1–20.

    Article  PubMed  Google Scholar 

  8. Sciaudone G, Di Stazio C, Limongelli P, Guadagni I, Pellino G, Riegler G, Coscione P, Selvaggi F. Treatment of complex perianal fistulas in Crohn disease: infliximab, surgery or combined approach. Can J Surg. 2010;53(5):299–304.

    PubMed Central  PubMed  Google Scholar 

  9. Antakia R, Shorthouse AJ, Robinson K, Lobo AJ. Combined modality treatment for complex fistulating perianal Crohn’s disease. Colorectal Dis. 2013;15(2):210–6.

    Article  CAS  PubMed  Google Scholar 

  10. Rizzello F, Calabrese C, Calafiore A, Laureti S, Poggioli G, Campieri M, Gionchetti P. Adalimumab in the treatment of perianal Crohn’s disease: short and long term results in a Single Tertiary Center AGA Abstract Sa. 2014;S-358.

    Google Scholar 

  11. Dewint P, Hansen BE, Verhey E, Oldenburg B, Hommes DW, Pierik M, Ponsioen CI, van Dullemen HM, Russel M, van Bodegraven AA, van der Woude CJ. Adalimumab combined with ciprofloxacin is superior to adalimumab monotherapy in perianal fistula closure in Crohn’s disease: a randomised, double-blind, placebo controlled trial (ADAFI). Gut. 2014;63(2):292–9.

    Article  CAS  PubMed  Google Scholar 

  12. El-Gazzaz G, Hull T, Church JM. Biological immunomodulators improve the healing rate in surgically treated perianal Crohn’s fistulas. Colorectal Dis. 2012;14(10):1217–23.

    Article  CAS  PubMed  Google Scholar 

  13. Bouguen G, Siproudhis L, Gizard E, Wallenhorst T, Billioud V, Bretagne JF, Bigard MA, Peyrin-Biroulet L. Long-term outcome of perianal fistulizing Crohn’s disease treated with infliximab. Clin Gastroenterol Hepatol. 2013;11(8):975–81.

    Article  CAS  PubMed  Google Scholar 

  14. Garcia-Aguilar J, Belmonte C, Wong WD, Goldberg SM, Madoff RD. Cutting seton vs. two-stage seton fistulotomy in the surgical management of high anal fistula. Br J Surg. 1998;85:243–5.

    Article  CAS  PubMed  Google Scholar 

  15. Hamalainen KP, Sainio AP. Cutting seton for anal fistulas: high risk of minor control defects. Dis Colon Rectum. 1997;40:1443–6.

    Article  CAS  PubMed  Google Scholar 

  16. Ellis NC, Rostas JW, Greiner FG. Outcomes with bioprosthetic plugs for management of anal fistulas. Dis Colon Rectum. 2010;53:798–802.

    Article  PubMed  Google Scholar 

  17. Poggioli G, Laureti S, Pierangeli F, Rizzello F, Ugolini F, Gionchetti P, Campieri M. Local injection of Infliximab for the treatment of perianal Crohn’s disease. Dis Colon Rectum. 2005;48:768–74.

    Article  CAS  PubMed  Google Scholar 

  18. Poggioli G, Laureti S, Pierangeli F, Bazzi P, Coscia M, Gentilini L, Gionchetti P, Rizzello F. Local injection of adalimumab for perianal Crohn’s disease: better than infliximab? Inflamm Bowel Dis. 2010;16:1631.

    Article  CAS  PubMed  Google Scholar 

  19. Tonelli F, Giudici F, Asteria CR. Effectiveness and safety of local adalimumab injection in patients with fistulizing perianal Cohn’s disease: a pilot study. Dis Colon Rectum. 2012;55:870–5.

    Article  PubMed  Google Scholar 

  20. Asteria CR, Ficari F, Bagnoli S, Milla M, Tonelli F. Treatment of perianal fistulas in Crohn’s disease by local injection of antibody to TNF-alpha accounts for a favourable clinical response in selected cases: a pilot study. Scand J Gastroenterol. 2006;41:1064–72.

    Article  CAS  PubMed  Google Scholar 

  21. Laukoetter MG, Mennigen R, Hannig CM, Osada N, Rijcken E, Vowinkel T, Krieglstein CF, Senninger N, Anthoni C, Bruewer M. Intestinal cancer risk in Cohn’s disease: a meta-analysis. J Gastrointest Surg. 2011;15:576–83.

    Article  PubMed  Google Scholar 

  22. Thomas M, Bienkowski R, Vandermeer TJ, Trostle D, Cagir B. Malignant transformation in perianal fistulas of Cohn’s disease: a systematic review of literature. J Gastrointest Surg. 2010;14:66–73.

    Article  PubMed  Google Scholar 

  23. Beaugerie L, Itzkowitz SH. Cancers complicating inflammatory bowel disease. N Engl J Med. 2015;372(15):1441–52.

    Article  CAS  PubMed  Google Scholar 

  24. Whiteford MH, Kilkenny III M, Hyman N, Buie WD, Cohen J, Orsay C, Dunn G, Perry WB, Ellis CN, Rakinic J, Gregorcyk S, Shellito P, Nelson R, Tjandra JJ, Newstead G. Practice parameters for the treatment of perianal abscess and fistula-in-ano. Dis Colon Rectum. 2005;48:1337–42.

    Article  PubMed  Google Scholar 

  25. Soltani A, Kaiser AM. Endorectal advancement flap for cryptoglandular or Cohn’s fistula-in-ano. Dis Colon Rectum. 2010;53:486–95.

    Article  PubMed  Google Scholar 

  26. Jarrar A, Church J. Advancement flap repair: a good option for complex anorectal fistulas. Dis Colon Rectum. 2011;54(12):1537–41.

    Article  PubMed  Google Scholar 

  27. Rojanasakul A, Pattanaarun J, Sahakitrungruang C, Tantiphlachiva K. Total anal sphincter saving technique for fistula-in-ano; the ligation of intersphincteric fistula tract. J Med Assoc Thai. 2007;90(3):581–6.

    PubMed  Google Scholar 

  28. Rojanasakul A. LIFT procedure: a simplified technique for fistula-in- ano. Tech Coloproctol. 2009;13:237–40.

    Article  CAS  PubMed  Google Scholar 

  29. Gingold DS, Murrell ZA, Fleshner PR. A prospective evaluation of the ligation of the intersphincteric tract procedure for complex anal fistula in patients with Crohn’s disease. Ann Surg. 2014;260:1057–61.

    Article  PubMed  Google Scholar 

  30. Vergara-Fernandez O, Espino-Urbina LA. Ligation of intersphincteric fistula tract: what is the evidence in a review? World J Gastroenterol. 2013;19(40):6805–13.

    Article  PubMed Central  PubMed  Google Scholar 

  31. Cintron JR, Park JJ, Orsay CP, Pearl RK, Nelson RL, Sone JH, Song R, Abcarian H. Repair of fistulas-in-ano using fibrin adhesive: long-term follow-up. Dis Colon Rectum. 2000;43(7):944–9.

    Article  CAS  PubMed  Google Scholar 

  32. Sentovich SM. Fibrin glue for all anal fistulas. J Gastrointest Surg. 2001;5:158–61.

    Article  CAS  PubMed  Google Scholar 

  33. Tyler KM, Aarons CB, Sentovich SM. Successful sphincter-sparing surgery for all anal fistulas. Dis Colon Rectum. 2007;50:1535–9.

    Article  PubMed  Google Scholar 

  34. Loungnarath R, Dietz DW, Mutch MG, Birnbaum EH, Kodner IJ, Fleshman JW. Fibrin glue treatment of complex anal fistulas has a low success rate. Dis Colon Rectum. 2004;47:432–6.

    Article  PubMed  Google Scholar 

  35. Johnson EK, Gaw JU, Armstrong DN. Efficacy of anal fistula plug vs. fibrin glue in closure of anorectal fistulas. Dis Colon Rectum. 2006;49(3):371–6.

    Article  PubMed  Google Scholar 

  36. Cirocchi R, Santoro A, Trastulli S, Farinella E, Di Rocco G, Vendettuali D, Giannotti D, Redler A, Coccetta M, Gullà N, Boselli C, Avenia N, Sciannameo F, Basoli A. Meta-analysis of fibrin glue versus surgery for treatment of fistula-in-ano. Ann Ital Chir. 2010;81:349–56.

    PubMed  Google Scholar 

  37. Ellis CN, Clark S. Fibrin glue as an adjunct to flap repair of anal fistulas: a randomized, controlled study. Dis Colon Rectum. 2006;49(11):1736–40.

    Article  PubMed  Google Scholar 

  38. Hammond TM, Porrett TR, Scott SM, Williams NS, Lunniss PJ. Management of idiopathic anal fistula using cross-linked collagen: a prospective phase 1 study. Colorectal Dis. 2011;13(1):94–104.

    Article  CAS  PubMed  Google Scholar 

  39. Sileri P, Franceschilli L, Del Vecchio Blanco G, Stolfi VM, Angelucci GP, Gaspari AL. Porcine dermal collagen matrix injection may enhance flap repair surgery for complex anal fistula. Int J Colorectal Dis. 2011;26(3):345–9.

    Article  PubMed  Google Scholar 

  40. O’Connor L, Champagne BJ, Ferguson MA, Orangio GR, Schertzer ME, Armstrong DN. Efficacy of anal fistula plug in closure of Crohn’s anorectal fistulas. Dis Colon Rectum. 2006;49:1569–73.

    Article  PubMed  Google Scholar 

  41. Owen G, Keshava A, Stewart P, Patterson J, Chapuis P, Bokey E, Rickard M. Plugs unplugged. Anal fistula plug: the Concord experience. ANZ J Surg. 2010;80:341–3.

    Article  PubMed  Google Scholar 

  42. Thekkinkattil DK, Botterill I, Ambrose NS, Lundby L, Sagar PM, Buntzen S, Finan PJ. Efficacy of the anal fistula plug in complex anorectal fistulae. Colorectal Dis. 2009;11:584–7.

    Article  CAS  PubMed  Google Scholar 

  43. Köckerling F, von Rosen T, Jacob D. Modified plug repair with limited sphincter sparing fistulectomy in the treatment of complex anal fistulas. Front Surg. 2014;1:17. www.frontiersin.org.

  44. Ratto C, Litta F, Parello A, Donisi L, Zaccone G, De Simone V. Gore Bio-A Fistula Plug: a new sphincter-sparing procedure for complex anal fistula. Colorectal Dis. 2012;14:e264–9.

    Article  CAS  PubMed  Google Scholar 

  45. de la Portilla F, Rada R, Jiménez-Rodríguez R, Díaz-Pavón JM, Sánchez-Gil JM. Evaluation of a new synthetic plug in the treatment of anal fistulas: results of a pilot study. Dis Colon Rectum. 2011;54(11):1419–22.

    Article  PubMed  Google Scholar 

  46. Buchberg B, Masoomi H, Choi J, Bergman H, Mills S, Stamos MJ. A tale of two (anal fistula) plug: is there a difference in short-term outcomes? Ann Surg. 2010;76:1150–3.

    Google Scholar 

  47. García-Olmo D, García-Arranz M, Herreros D, Pascual I, Peiro C, Rodríguez-Montes JA. A phase I clinical trial of the treatment of Crohn’s fistula by adipose mesenchymal stem cell transplantation. Dis Colon Rectum. 2005;48:1416–23.

    Article  PubMed  Google Scholar 

  48. Garcia-Olmo D, Herreros D, Pascual I, Pascual JA, Del-Valle E, Zorrilla J, De-La-Quintana P, Garcia-Arranz M, Pascual M. Expanded adipose-derived stem cells for the treatment of complex perianal fistula: a phase II clinical trial. Dis Colon Rectum. 2009;52:79–86.

    Article  PubMed  Google Scholar 

  49. Lee WY, Park KJ, Cho YB, Yoon SN, Song KH, Kim DS, Jung SH, Kim M, Yoo HW, Kim I, Ha H, Yu CS. Autologous adipose tissue-derived stem cells treatment demonstrated favorable and sustainable therapeutic effect for Cohn’s fistula. Stem Cells. 2013;31:2575–81.

    Article  CAS  PubMed  Google Scholar 

  50. Ciccocioppo R, Bernardo ME, Sgarella A, Maccario R, Avanzini MA, Ubezio C, Minelli A, Alvisi C, Vanoli A, Calliada F, Dionigi P, Perotti C, Locatelli F, Corazza GR. Autologous bone marrow-derived mesenchymal stromal cells in the treatment of fistulising Crohn’s disease. Gut. 2011;60:788–98.

    Article  PubMed  Google Scholar 

  51. de la Portilla F, Alba F, García-Olmo D, Herrerías JM, González FX, Galindo A. Expanded allogeneic adipose-derived stem cells (eASCs) for the treatment of complex perianal fistula in Crohn’s disease: results from a multicenter phase I/IIa clinical trial. Int J Colorectal Dis. 2013;28:313–23.

    Article  PubMed  Google Scholar 

  52. Marzo M, Felice C, Pugliese D, Andrisani G, Mocci G, Armuzzi A, Guidi L. Management of perianal fistulas in Crohn’s disease: an up-to-date review. World J Gastroenterol. 2015;21(5):1394–403.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  53. Yamamoto T, Bain IM, Allan RN, Keighley MR. Persistent perineal sinus after proctocolectomy for Crohn’s disease. Dis Colon Rectum. 1999;42:96–101.

    Article  CAS  PubMed  Google Scholar 

  54. Maeda Y, Heyckendorff-Diebold T, Tei TM, Lundby L, Buntzen S. Gracilis muscle transposition for complex fistula and persistent nonhealing sinus in perianal Crohn’s disease. Inflamm Bowel Dis. 2011;17:583–9.

    Article  PubMed  Google Scholar 

  55. Jacob TJ, Perakath B, Keighley MR. Surgical intervention for anorectal fistula. Cochrane Database Syst Rev. 2010;(5):CD006319.

    Google Scholar 

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Authors and Affiliations

  1. UOC General Surgery, “V. Cervello” Hospital, Azienda Ospedaliera “Ospedali Riuniti Villa Sofia-Cervello”, Palermo, Italy

    Gaspare Solina

  2. UOC Internal Medicine, “V. Cervello” Hospital, Azienda Ospedaliera “Ospedali Riuniti Villa Sofia-Cervello”, Palermo, Italy

    Sara Renna & Ambrogio Orlando

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  1. Gaspare Solina
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  2. Sara Renna
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  3. Ambrogio Orlando
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Correspondence to Gaspare Solina .

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Editors and Affiliations

  1. Radiology Department, Policlinico Paolo Giaccone, Palermo, Italy

    Giuseppe Lo Re

  2. Radiology Department, University of Palermo, Policlinico Paolo Giaccone, Palermo, Italy

    Massimo Midiri

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Solina, G., Renna, S., Orlando, A. (2016). Perianal Surgery in Crohn’s Disease. In: Lo Re, G., Midiri, M. (eds) Crohn’s Disease. Springer, Cham. https://doi.org/10.1007/978-3-319-23066-5_18

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  • DOI: https://doi.org/10.1007/978-3-319-23066-5_18

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