Treatment of perianal crohn disease fistulae

Abstract

The treatment of perianal fistulizing Crohn disease has evolved greatly in the last fifteen years, due largely to improvements in medical therapy. Tables 33.2 and 33.3 summarize all published controlled and uncontrolled trials of immunomodulator and biological therapy for the treatment of Crohn fistulae. The advent of immunomodulators and anti-TNF-β agents has transformed the treatment of Crohn fistulae from almost exclusively surgical to placing a much larger emphasis on medical therapy, either as initial therapy alone, with surgery reserved for refractory cases, or [figure presented] in combination with surgery from the start. For this reason, gastroenterologists and surgeons must work in concert in order to provide the best care for each patient. Proper fistula management also relies heavily on accurate diagnosis, especially defining the anatomy of the fistula, ascertaining whether abscess formation is present, and determining the location and extent of intestinal inflammation. © 2008 Springer Science+Business Media, LLC. All rights reserved.