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Crohn¡¯s Anal Fistula and Perianal Abscess: Results of Surgical Treatment
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ÀÌÀμ· ( Lee In-Seob )
¼¿ï´ëÇб³ ÀÇ°ú´ëÇÐ ¿Ü°úÇб³½Ç
ÃÖÀº°æ ( Choe Eun-Kyung )
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¹Ú¼ºÂù ( Park Sung-Chan )
¼¿ï´ëÇб³ ÀÇ°ú´ëÇÐ ¿Ü°úÇб³½Ç
¹Ú±ÔÁÖ ( Park Kyu-Joo )
¼¿ï´ëÇб³ ÀÇ°ú´ëÇÐ ¿Ü°úÇб³½Ç
KMID : 0356720070230060424
Abstract
Purpose: In this paper, we intend to review the postoperative course of patients with a Crohn¡¯s anal fistula and/or perianal abscess and determine the relationship between the healing time and Crohn¡¯s Disease Acitivity Index (CDAI), the extent of intestinal unflammation, and the types of medical treatment.
Methods: We performed a clinical analysis of the records of 25 Crohn¡¯s anal fistula patients (35 operation cases). All patients had undergone operations involving one surgeon at the same hospital between August 1998 and October 2006. We divided the patients into 2 groups (simple vs. complex fistula) and investigated the treatment and clinical course of each group.
Results: The mean age of the patients was 27 years old; the numbers of simple and complex fistulas were 5 (14.3%) and 30 (85.7%), respectively. All simple-group patients healed without recurrence. Moreover, there was no difference in healing time compared with the non-Crohn¡¯s patients in the simple- type group (50.4 vs. 45.6 days, P=0.976). However, in the complex group, only 23 cases healed, and the healing time was prolonged significantly compared with that for the non- Crohn¡¯s patients in the complex-type group (213 vs. 80 days, P=0.036). The mean healing time was 185.4 days, the number of operations was 1.64, the recurrence rate 32%, and the time to recurrence was about 900 days. Neither CDAI value (mean: 141.6) nor the extent of intestinal inflammation (including rectal inflammation) had any relationship with the healing time (P=0.392, P= 0.911). All patients used azathioprine during treatment, and neither infliximab nor prednisolone medication had any statistically significant effect on the healing time (P=0.73, 0.59).
Conclusions: The postoperative course of patients in the simple-type group was the same as that for patients with a non-Crohn¡¯s anal fistula. On the other hands in the complex-type group, there was frequent recurrence and slow recovery, regardless of the type of operation or medical treatment. J Korean Soc Coloproctol 2007;23:424-430
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Crohn;Anal fistula;Healing;Recurrence
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