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Systematic review: the combined surgical and medical treatment of fistulising perianal Crohn's disease
Author(s) -
Yassin N. A.,
Askari A.,
Warusavitarne J.,
Faiz O. D.,
Athanasiou T.,
Phillips R. K. S.,
Hart A. L.
Publication year - 2014
Publication title -
alimentary pharmacology and therapeutics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.308
H-Index - 177
eISSN - 1365-2036
pISSN - 0269-2813
DOI - 10.1111/apt.12906
Subject(s) - medicine , medical therapy , crohn's disease , surgery , fistula , population , randomized controlled trial , disease , medical nutrition therapy , environmental health
Summary Background The management of perianal Crohn's fistulas represents a significant challenge. A combination of medical and surgical therapy, guided by radiology, is often required. Aim To review systematically the literature to assess fistula healing rates with medical treatment (anti‐ TNF ‐α therapies ± immunomodulators) or surgical treatment alone, compared with combined medical and surgical treatment in fistulising perianal Crohn's disease ( CD ). Methods The Preferred Reporting Items for Systematic Reviews and Meta‐Analyses ( PRISMA ) guidelines were used. Two independent reviewers searched the literature. Results Twenty‐four articles were included. The total population was 1139 patients; 460 (40%) received single treatment with either medical or surgical therapy, and 679 (60%) received combined medical and surgical therapy. Eight studies compared single and combination therapy, with a total population of 797 patients (single therapy: n = 448, combination therapy: n = 349). In the single therapy group, 191/448 were in complete remission (43%). This was lower than the healing rate of the combination therapy group 180/349 (52%). No response to therapy was noted in 34% (153/448) of the single therapy group compared with 23% (80/349) of the combination group. Conclusions Combined surgical and medical (anti‐ TNF ‐α ± immunomodulators) therapy may have additional beneficial effects on perianal fistula healing in patients with Crohn's disease, compared with surgery or medical therapy alone. A well‐designed Crohn's perianal fistula clinical trial is required in a multidisciplinary medical and surgical setting, with clearly defined end points of clinical (and likely patient reported outcomes) and radiological healing.