Surgical management of anorectal fistulas in Crohn's disease
作者:
John Morrison,
J. Gathright,
John Ray,
Bernard Ferrari,
Terry Hicks,
Alan Timmcke,
期刊:
Diseases of the Colon & Rectum
(OVID Available online 1989)
卷期:
Volume 32,
issue 6
页码: 492-496
ISSN:0012-3706
年代: 1989
出版商: OVID
关键词: Anorectal fistulas;Crohn's disease
数据来源: OVID
摘要:
&NA;A retrospective review of patients with Crohn's disease treated at our institution from 1973 to 1986 revealed 35 patients operated upon for anorectal fistulas. Twenty‐nine had low intermuscular fistulas (multiple in seven), and six had high intermuscular (supralevator) fistulas. Fistulotomy alone was performed in 19 patients, and eight underwent partial fistulotomy and seton insertion. Five additional patients had proximal fecal diversion before fistulotomy. Three patients with severe colonic and anorectal disease underwent proctocolectomy as the initial procedure. Of the 32 patients who had fistulotomy performed, complete healing occurred in 30. Seven patients who healed required more than one operation for fistula. One patient was left with an asymptomatic fistula, and one required proctectomy for persistent symptomatic fistula and proctitis. Success of operation correlated with absence of rectal disease and quiescent disease elsewhere in the gastrointestinal tract. Aggressive medical treatment is required to control bowel disease preoperatively. In the majority of patients, subsequent surgery is justified and healing can be anticipated.
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