Ambulatory Surgery for Perianal Crohn’s Disease: Study of Feasibility
Background. One-third of Crohn’s disease (CD) patients present perianal fistula. The gold standard in the diagnosis and treatment of symptomatic perianal disease (PAD) in CD is the exploration of the anal canal and distal rectum under anesthesia (EUA). This procedure is mainly conducted as a day cas...
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Wiley
2018-01-01
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| Series: | Gastroenterology Research and Practice |
| Online Access: | http://dx.doi.org/10.1155/2018/5249087 |
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| author | S. Sibio A. Di Giorgio M. Campanelli S. Di Carlo A. Divizia C. Fiorani R. Scaramuzzo C. Arcudi G. Del Vecchio Blanco L. Biancone G. Sica |
| author_facet | S. Sibio A. Di Giorgio M. Campanelli S. Di Carlo A. Divizia C. Fiorani R. Scaramuzzo C. Arcudi G. Del Vecchio Blanco L. Biancone G. Sica |
| author_sort | S. Sibio |
| collection | DOAJ |
| description | Background. One-third of Crohn’s disease (CD) patients present perianal fistula. The gold standard in the diagnosis and treatment of symptomatic perianal disease (PAD) in CD is the exploration of the anal canal and distal rectum under anesthesia (EUA). This procedure is mainly conducted as a day case surgery. Unfortunately, it is not always possible to proceed within the ideal timing and any delay may well represent a relevant clinical issue. The aim of this study was to evaluate the feasibility of outpatient treatment of symptomatic perianal fistulas in CD patients. Methods. All CD patients under regular follow-up at our inflammatory bowel disease referral center, presenting with symptomatic perianal fistulas, were offered surgical consultation. The data of patients were prospectively collected for three years (February 2014 to February 2017) for the purpose of the study. All clinical information, including previous EUA and/or records from MRI and endoscopic ultrasound, was included. Outpatient anal canal and distal rectum exploration and treatment (OE) were undertaken during the specialist surgical consultation. Fistulas were classified according to Parks’s classification; the type of outpatient treatment and compliance of patients were recorded. Pain was assessed by VAS at the time of the procedure and during the first control. Patients were followed up in the surgical clinic in relation to the study. Results. Ninety-two CD patients with symptomatic perianal fistulas had surgical consultation during the study period. OE was offered to all but 18 patients who fulfilled the exclusion criteria or had an extremely severe disease; six patients refused the OE (8.11%). Of the 68 patients undergoing OE, eleven (16.18%) had previous surgery for perianal disease. The OE was accomplished in sixty-one patients (89.71%), while in 7 patients, it was abandoned for scarce compliance. Nine patients (14.75%) underwent drainage of perianal abscess; in 3 of them, it was possible to probe the fistula tract, find the internal orifice, and pass a loose seton. Overall, setonage was performed in 50 patients (81.97%). Rectovaginal setons were placed in 3 patients and more than one seton (up to 3) in 6 cases. Fistulotomy was performed in 4 simple subcutaneous fistulous tracts. Concordance with the preoperative findings was found in 54 out of 61 patients. EUA was scheduled at the time of OE for the 7 patients who did not complete the procedure. All sixty-one patients who had the OE were followed up for a minimum of 12 months. Conclusions. This preliminary study indicates that OE in CD patients with symptomatic perianal fistulas is safe and feasible in a high-volume referral center. It might provide several benefits, including patients’ logistics, reduce or remove patients’ symptoms and discomfort, allow for a timely start of medical therapy, and avoid further complications. |
| format | Article |
| id | doaj-art-cd272a2a3b9c40238a20df13a8dd68ac |
| institution | Kabale University |
| issn | 1687-6121 1687-630X |
| language | English |
| publishDate | 2018-01-01 |
| publisher | Wiley |
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| series | Gastroenterology Research and Practice |
| spelling | doaj-art-cd272a2a3b9c40238a20df13a8dd68ac2025-02-03T01:11:14ZengWileyGastroenterology Research and Practice1687-61211687-630X2018-01-01201810.1155/2018/52490875249087Ambulatory Surgery for Perianal Crohn’s Disease: Study of FeasibilityS. Sibio0A. Di Giorgio1M. Campanelli2S. Di Carlo3A. Divizia4C. Fiorani5R. Scaramuzzo6C. Arcudi7G. Del Vecchio Blanco8L. Biancone9G. Sica10Department of Surgery “Pietro Valdoni”, Sapienza University of Rome, Via Lancisi 2, 00155 Rome, ItalyPoliclinico Tor Vergata, Department of Surgery, University Tor Vergata, Viale Oxford 81, 00133 Rome, ItalyPoliclinico Tor Vergata, Department of Surgery, University Tor Vergata, Viale Oxford 81, 00133 Rome, ItalyPoliclinico Tor Vergata, Department of Surgery, University Tor Vergata, Viale Oxford 81, 00133 Rome, ItalyPoliclinico Tor Vergata, Department of Surgery, University Tor Vergata, Viale Oxford 81, 00133 Rome, ItalyPoliclinico Tor Vergata, Department of Surgery, University Tor Vergata, Viale Oxford 81, 00133 Rome, ItalyPoliclinico Tor Vergata, Department of Surgery, University Tor Vergata, Viale Oxford 81, 00133 Rome, ItalyPoliclinico Tor Vergata, Department of Surgery, University Tor Vergata, Viale Oxford 81, 00133 Rome, ItalyPoliclinico Tor Vergata, Department of Medicine, University Tor Vergata, Viale Oxford 81, 00133 Rome, ItalyPoliclinico Tor Vergata, Department of Medicine, University Tor Vergata, Viale Oxford 81, 00133 Rome, ItalyPoliclinico Tor Vergata, Department of Surgery, University Tor Vergata, Viale Oxford 81, 00133 Rome, ItalyBackground. One-third of Crohn’s disease (CD) patients present perianal fistula. The gold standard in the diagnosis and treatment of symptomatic perianal disease (PAD) in CD is the exploration of the anal canal and distal rectum under anesthesia (EUA). This procedure is mainly conducted as a day case surgery. Unfortunately, it is not always possible to proceed within the ideal timing and any delay may well represent a relevant clinical issue. The aim of this study was to evaluate the feasibility of outpatient treatment of symptomatic perianal fistulas in CD patients. Methods. All CD patients under regular follow-up at our inflammatory bowel disease referral center, presenting with symptomatic perianal fistulas, were offered surgical consultation. The data of patients were prospectively collected for three years (February 2014 to February 2017) for the purpose of the study. All clinical information, including previous EUA and/or records from MRI and endoscopic ultrasound, was included. Outpatient anal canal and distal rectum exploration and treatment (OE) were undertaken during the specialist surgical consultation. Fistulas were classified according to Parks’s classification; the type of outpatient treatment and compliance of patients were recorded. Pain was assessed by VAS at the time of the procedure and during the first control. Patients were followed up in the surgical clinic in relation to the study. Results. Ninety-two CD patients with symptomatic perianal fistulas had surgical consultation during the study period. OE was offered to all but 18 patients who fulfilled the exclusion criteria or had an extremely severe disease; six patients refused the OE (8.11%). Of the 68 patients undergoing OE, eleven (16.18%) had previous surgery for perianal disease. The OE was accomplished in sixty-one patients (89.71%), while in 7 patients, it was abandoned for scarce compliance. Nine patients (14.75%) underwent drainage of perianal abscess; in 3 of them, it was possible to probe the fistula tract, find the internal orifice, and pass a loose seton. Overall, setonage was performed in 50 patients (81.97%). Rectovaginal setons were placed in 3 patients and more than one seton (up to 3) in 6 cases. Fistulotomy was performed in 4 simple subcutaneous fistulous tracts. Concordance with the preoperative findings was found in 54 out of 61 patients. EUA was scheduled at the time of OE for the 7 patients who did not complete the procedure. All sixty-one patients who had the OE were followed up for a minimum of 12 months. Conclusions. This preliminary study indicates that OE in CD patients with symptomatic perianal fistulas is safe and feasible in a high-volume referral center. It might provide several benefits, including patients’ logistics, reduce or remove patients’ symptoms and discomfort, allow for a timely start of medical therapy, and avoid further complications.http://dx.doi.org/10.1155/2018/5249087 |
| spellingShingle | S. Sibio A. Di Giorgio M. Campanelli S. Di Carlo A. Divizia C. Fiorani R. Scaramuzzo C. Arcudi G. Del Vecchio Blanco L. Biancone G. Sica Ambulatory Surgery for Perianal Crohn’s Disease: Study of Feasibility Gastroenterology Research and Practice |
| title | Ambulatory Surgery for Perianal Crohn’s Disease: Study of Feasibility |
| title_full | Ambulatory Surgery for Perianal Crohn’s Disease: Study of Feasibility |
| title_fullStr | Ambulatory Surgery for Perianal Crohn’s Disease: Study of Feasibility |
| title_full_unstemmed | Ambulatory Surgery for Perianal Crohn’s Disease: Study of Feasibility |
| title_short | Ambulatory Surgery for Perianal Crohn’s Disease: Study of Feasibility |
| title_sort | ambulatory surgery for perianal crohn s disease study of feasibility |
| url | http://dx.doi.org/10.1155/2018/5249087 |
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