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Association of Coloproctology of Great Britain and Ireland consensus exercise on surgical management of fistulating perianal Crohn's disease
Author(s) -
Lee M. J.,
Heywood N.,
Sagar P. M.,
Brown S. R.,
Fearnhead N. S.
Publication year - 2017
Publication title -
colorectal disease
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.029
H-Index - 89
eISSN - 1463-1318
pISSN - 1462-8910
DOI - 10.1111/codi.13672
Subject(s) - medicine , voting , likert scale , medline , family medicine , psychological intervention , general surgery , nursing , statistics , mathematics , politics , political science , law
Aim Management of fistulating perianal Crohn's disease (fp CD ) is a significant challenge for a colorectal surgeon. A recent survey of surgical practice in this condition showed variation in management approaches. As a result we set out to devise recommendations for practice for UK colorectal surgeons. Method Results from a national survey were used to devise a set of potential consensus statements. Consultant colorectal surgeons were invited to participate in the exercise via the previous survey and the mailing list of the professional society. Iterative voting was performed on each statement using a five‐point Likert scale and electronic voting, with opportunity for discussion and refinement between each vote. Consensus was defined as > 80% agreement. Results Seventeen surgeons and two patient representatives voted upon 51 statements. Consensus was achieved on 39 items. Participants advocated a patient‐centred approach by a colorectal specialist, within strong multidisciplinary teamworking. The use of anti‐ TNF α therapy is advocated. Where definitive surgical techniques are considered they should be carefully selected to avoid adverse impact on function. Ano/rectovaginal fistulas should be managed by specialists in fistulating disease. Stoma or proctectomy could be discussed earlier in a patient's treatment pathway to improve choice, as they may improve quality of life. Conclusion This consensus provides principles and guidance for best practice in managing patients with fp CD .