20-YEAR REVIEW OF THE SURGICAL-MANAGEMENT OF PERIANAL CROHNS-DISEASE

PURPOSE: A retrospective analysis of 48 patients treated over a 20-yea r period (March 1973-April 1993) was undertaken to assess the results of our practice of early surgical intervention in suppurative complica tions of perianal Crohn's disease. METHODS: All patients were either s een in the office within the last six months or contacted by phone. RE SULTS: The average age of our patients was 30 years at initial diagnos is. Thirty-four patients (71 percent) initially presented with intesti nal disease and four (8 percent) with only perianal disease. Thirteen patients (27 percent) initially presented with simultaneous intestinal and perianal disease. The various fistulas at initial presentation in cluded 8 intersphincteric (17 percent), 14 transphincteric (29 percent ), 11 complex or multiple (23 percent), 5 rectovaginal (10 percent), a nd 2 unclassified, for a total of 40 patients. Eight patients (17 perc ent) presented with only an abscess. Eighty five percent of our patien ts healed after their first procedure, with an average time to heal of 2.8 months. Thirteen (27 percent) patients had recurrences after init ial healing of their wounds. The mean time to recurrence after healing was 5.25 years. Fifty-four percent of our recurrences (7 patients) we re treated by incision and drainage of an abscess only. Seven of 13 re currences healed after the second procedure (54 percent), and 5 of 6 h ealed after a third procedure (83 percent). Only seven (14 percent) of our patients underwent a proctocolectomy during the study period, thr ough September, 1993. Our overall probability of avoiding proctectomy and healing perineal wounds of 86 percent is consistent with published literature. CONCLUSIONS: Early aggressive surgical management of supp urative complications of perianal Crohn's disease before complex manag ement problems ensue results in a high incidence of healing and a low risk of subsequent proctectomy.