Crohn's Anal Fistula and Perianal Abscess: Results of Surgical Treatment

ABSTRACT

PURPOSE: In this paper, we intend to review the postoperative course of patients with a Crohn's anal fistula and/or perianal abscess and determine the relationship between the healing time and Crohn's Disease Acitivity Index (CDAI), the extent of intestinal unflammation, and the types of medical treatment. METHODS: We performed a clinical analysis of the records of 25 Crohn's anal fistula patients (35 operation cases). All patients had undergone operations involving one surgeon at the same hospital between August 1998 and October 2006. We divided the patients into 2 groups (simple vs. complex fistula) and investigated the treatment and clinical course of each group. RESULTS: The mean age of the patients was 27 years old; the numbers of simple and complex fistulas were 5 (14.3%) and 30 (85.7%), respectively. All simple-group patients healed without recurrence. Moreover, there was no difference in healing time compared with the non-Crohn's patients in the simple-type group (50.4 vs. 45.6 days, P=0.976). However, in the complex group, only 23 cases healed, and the healing time was prolonged significantly compared with that for the non-Crohn's patients in the complex-type group (213 vs. 80 days, P=0.036). The mean healing time was 185.4 days, the number of operations was 1.64, the recurrence rate 32%, and the time to recurrence was about 900 days. Neither CDAI value (mean 141.6) nor the extent of intestinal inflammation (including rectal inflammation) had any relationship with the healing time (P=0.392, P= 0.911). All patients used azathioprine during treatment, and neither infliximab nor prednisolone medication had any statistically significant effect on the healing time (P=0.73, 0.59). CONCLUSIONS: The postoperative course of patients in the simple-type group was the same as that for patients with a non-Crohn's anal fistula. On the other hands in the complex-type group, there was frequent recurrence and slow recovery, regardless of the type of operation or medical treatment.