Modern surgical strategies for perianal Crohn's disease

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Zabot, Gilmara Pandolfo
Cassol, Ornella
Saad-Hossne, Rogerio [UNESP]
Bemelman, Willem

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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.



Anorectal fistula, Crohn's disease, Inflammatory bowel disease, Perianal fistulas, Surgical treatment

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World Journal of Gastroenterology, v. 26, n. 42, p. 6572-6581, 2020.