Abstract
Background: Perianal abscesses and fistulae have been reported in approximately 15% of patients with paediatric Crohn's disease and they are associated with poor quality of life. Several surgical techniques were proposed for the treatment of perianal Crohn's disease, characterized by an elevated incidence of failure, incontinence, and relapse.Aim of our study was to present the technical details and results of our surgical technique in case of recurrent, persistent, complex perianal ano-rectal destroying Crohn's disease not responding to medical treatment. Methods: Data of patients who underwent surgical treatment (cone-like resection, fistulectomy, sphincter reconstruction, endorectal advancement sleeve flaps like in Soave endorectal pull-through) for complicated high-level trans, inter or suprasphincteric fistulae between January 2009 and June 2014 were retrospectively reviewed. Results: 20 surgical procedures were performed in 11 patients (males 72.7%) with transsphincteric (n= 5), intersphincteric (n= 4) and suprasphincteric (n= 2) fistulae. Three patients needed a second treatment. Two patients needed more than 2 surgeries and one temporary colostomy. No patient presented anal incontinence at 15 months' median follow-up. Conclusions: Although several procedures may be required to obtain a complete remission of perianal lesions, in our series the proposed surgical technique seemed effective and safe, preserving anal continence in all treated cases and reducing the need of faecal diversion.
| Original language | English |
|---|---|
| Pages (from-to) | 658-662 |
| Number of pages | 5 |
| Journal | Digestive and Liver Disease |
| Volume | 47 |
| Issue number | 8 |
| DOIs | |
| Publication status | Published - Aug 1 2015 |
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Keywords
- Complex fistula
- Cone-like resection
- Paediatric
- Perianal Crohn's
ASJC Scopus subject areas
- Gastroenterology
- Hepatology
Cite this
Cone-like resection, fistulectomy and mucosal rectal sleeve partial endorectal pull-through in paediatric Crohn's disease with perianal complex fistula. / Mattioli, Girolamo; Pio, Luca; Arrigo, Serena; Pini Prato, Alessio; Montobbio, Giovanni; Disma, Nicola Massimo; Barabino, Arrigo.
In: Digestive and Liver Disease, Vol. 47, No. 8, 01.08.2015, p. 658-662.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Cone-like resection, fistulectomy and mucosal rectal sleeve partial endorectal pull-through in paediatric Crohn's disease with perianal complex fistula
AU - Mattioli, Girolamo
AU - Pio, Luca
AU - Arrigo, Serena
AU - Pini Prato, Alessio
AU - Montobbio, Giovanni
AU - Disma, Nicola Massimo
AU - Barabino, Arrigo
PY - 2015/8/1
Y1 - 2015/8/1
N2 - Background: Perianal abscesses and fistulae have been reported in approximately 15% of patients with paediatric Crohn's disease and they are associated with poor quality of life. Several surgical techniques were proposed for the treatment of perianal Crohn's disease, characterized by an elevated incidence of failure, incontinence, and relapse.Aim of our study was to present the technical details and results of our surgical technique in case of recurrent, persistent, complex perianal ano-rectal destroying Crohn's disease not responding to medical treatment. Methods: Data of patients who underwent surgical treatment (cone-like resection, fistulectomy, sphincter reconstruction, endorectal advancement sleeve flaps like in Soave endorectal pull-through) for complicated high-level trans, inter or suprasphincteric fistulae between January 2009 and June 2014 were retrospectively reviewed. Results: 20 surgical procedures were performed in 11 patients (males 72.7%) with transsphincteric (n= 5), intersphincteric (n= 4) and suprasphincteric (n= 2) fistulae. Three patients needed a second treatment. Two patients needed more than 2 surgeries and one temporary colostomy. No patient presented anal incontinence at 15 months' median follow-up. Conclusions: Although several procedures may be required to obtain a complete remission of perianal lesions, in our series the proposed surgical technique seemed effective and safe, preserving anal continence in all treated cases and reducing the need of faecal diversion.
AB - Background: Perianal abscesses and fistulae have been reported in approximately 15% of patients with paediatric Crohn's disease and they are associated with poor quality of life. Several surgical techniques were proposed for the treatment of perianal Crohn's disease, characterized by an elevated incidence of failure, incontinence, and relapse.Aim of our study was to present the technical details and results of our surgical technique in case of recurrent, persistent, complex perianal ano-rectal destroying Crohn's disease not responding to medical treatment. Methods: Data of patients who underwent surgical treatment (cone-like resection, fistulectomy, sphincter reconstruction, endorectal advancement sleeve flaps like in Soave endorectal pull-through) for complicated high-level trans, inter or suprasphincteric fistulae between January 2009 and June 2014 were retrospectively reviewed. Results: 20 surgical procedures were performed in 11 patients (males 72.7%) with transsphincteric (n= 5), intersphincteric (n= 4) and suprasphincteric (n= 2) fistulae. Three patients needed a second treatment. Two patients needed more than 2 surgeries and one temporary colostomy. No patient presented anal incontinence at 15 months' median follow-up. Conclusions: Although several procedures may be required to obtain a complete remission of perianal lesions, in our series the proposed surgical technique seemed effective and safe, preserving anal continence in all treated cases and reducing the need of faecal diversion.
KW - Complex fistula
KW - Cone-like resection
KW - Paediatric
KW - Perianal Crohn's
UR - http://www.scopus.com/inward/record.url?scp=84937512551&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84937512551&partnerID=8YFLogxK
U2 - 10.1016/j.dld.2015.05.003
DO - 10.1016/j.dld.2015.05.003
M3 - Article
C2 - 26048251
AN - SCOPUS:84937512551
VL - 47
SP - 658
EP - 662
JO - Digestive and Liver Disease
JF - Digestive and Liver Disease
SN - 1590-8658
IS - 8
ER -