MANAGEMENT OF PERIANAL CROHNS-DISEASE - RESULTS OF A MULTICENTER STUDY IN ITALY

PURPOSE: Management of perianal Crohn's disease is still controversial , and reports on large series are very few in the literature. The aim of this multicenter study was to investigate the outcome of both medic al and surgical treatment in 225 patients. METHODS: Patients cared for at different institutions were followed up for a median of six years. Most of them had either anal fistula or an abscess (86 percent and 43 percent, respectively), but fissures were also present in 26 percent of the cases. Diarrhea and anal pain were the most common symptoms. An al lesions preceded the onset of intestinal symptoms in 19 percent of cases. RESULTS: Medical treatment was curative only in 21 of 123 patie nts. Overall, medical and surgical treatment either cured or improved 62 percent of the cases. Fifty percent had an intestinal resection. Ab scess drainage and fistulotomy were the most common anal surgeries. Re ctovaginal fistulas (n = 30) required intestinal surgery in 36 percent and anal surgery in 20 percent of the cases, 50 percent with good res ults. Of 166 patients who had anal surgery, 97 (58 percent) had a posi tive outcome. Recurrence of anal disease requiring further surgery occ urred in 24.5 percent of the cases. CONCLUSIONS: Limited surgeries see m to achieve satisfactory results in more than one-half of the patient s affected by perianal Crohn's lesions, whereas medical treatment alon e is curative in a small portion of them.