Clinical Studies of Definitive Surgery for Anal Fistula in Crohn's Disease

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  • クローン病の痔瘻に対する根治手術症例の検討

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Abstract

<p>Purpose: To evaluate the applicability of definitive surgery for anal fistula in Crohn's disease (CD).</p><p>Methods: We studied 81 CD fistula cases (42 “CD-operated cases”, 39 “CD-non-operated cases”) and 119 “non-CD-operated cases”. Indications for definitive surgery were as follows: controlled intestinal lesions, primary opening of the fistula situated caudal to the puborectalis muscle, and lesions that were relatively localized and formed fistula tracts. Definitive surgery was performed by fistulotomy between the internal opening and the primary lesion, and resection or seton procedure for the ducts distant from the primary lesion.</p><p>Results: Although the average healing time (130.6±75.0 days) was about twice that of non-CD-operated cases (64.9±35.4 days) due to excessive granulation and prolonged epithelialization, 41 of 42 CD-operated cases (97.6%) were cured without incontinence. There was no difference in the number of fistulas, detection rates of non-caseating epithelioid granulomas, or average healing time between secondary and incidental lesion cases. These results suggest that they should be treated as similar conditions. Healing tended to be earlier in cases where biologics were used.</p><p>Conclusion: We believe that definitive surgery may be indicated for anal fistulas in CD, provided indications for surgery are strictly applied and appropriate surgery can be performed.</p>

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