Surgical management of anorectal fistulas in Crohn's disease |
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Authors: | John G Morrison MD J Byron Gathright Jr MD John E Ray MD Bernard T Ferrari MD Terry C Hicks MD Alan E Timmcke MD |
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Institution: | (1) Department of Colon and Rectal Surgery, Ochsner Clinic and Alton Ochsner Medical Foundation, 1514 Jefferson Highway, 70121 New Orleans, Louisiana |
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Abstract: | A retrospective review of patients with Crohn's disease treated at our institution from 1973 to 1986 revealed 35 patients
operated upon for anorectal fistulas. Twenty-nine had low intermuscular fistulas (multiple in seven), and six had high intermuscular
(supralevator) fistulas. Fistulotomy alone was performed in 19 patients, and eight underwent partial fistulotomy and seton
insertion. Five additional patients had proximal fecal diversion before fistulotomy. Three patients with severe colonic and
anorectal disease underwent proctocolectomy as the initial procedure. Of the 32 patients who had fistulotomy performed, complete
healing occurred in 30. Seven patients who healed required more than one operation for fistula. One patient was left with
an asymptomatic fistula, and one required proctectomy for persistent symptomatic fistula and proctitis. Success of operation
correlated with absence of rectal disease and quiescent disease elsewhere in the gastrointestinal tract. Aggressive medical
treatment is required to control bowel disease preoperatively. In the majority of patients, subsequent surgery is justified
and healing can be anticipated.
Read at the meeting of the American Society of Colon and Rectal Surgeons, Anaheim, California, June 12 to 17, 1988.
Read at the XIIth Biennial Congress of the International Society of University Colon and Rectal Surgeons, Glasgow, Scotland,
July 10 to 14, 1988. |
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Keywords: | Anorectal fistulas Crohn's disease |
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