Perianal
fistulas are a frequent and debilitating complication of Crohn’s disease (CD),
affecting up to one-third of patients and significantly impairing quality of
life. The thesis "Surgical Treatment of Crohn’s
Perianal Fistulas" explores
surgical outcomes, novel therapies, and diagnostic tools to improve management
strategies.
Part 1 reviews global trends in surgical randomized
controlled trials (RCTs) from 1999, 2009, and 2019, showing stable publication
volumes but improved methodological quality, with a notable shift towards Asia,
particularly China.
Part 2 focuses on outcomes in perianal fistula surgery.
Early CD diagnosis is associated with better healing outcomes. Both the LIFT
and advancement flap (AF) procedures demonstrated a 71% clinical closure rate
and improved quality of life, especially in patients who achieved radiological
healing. In therapy-refractory cases, temporary faecal diversion often led to
permanent ostomy, though reversal was more successful in patients with
colostomies and concurrent anti-TNF therapy. Proctectomy outcomes showed that
total mesorectal excision and the use of anti-TNF improved perineal healing,
while cutaneous CD was a strong predictor of non-healing.
Part 3 explores innovative treatments. Mesenchymal stem
cell therapy (MST) showed promising results, with 70% clinical closure and
43.3% radiological healing. Vacuum therapy using the Semiflex catheter was
feasible in 65% of patients but limited by technical challenges. Lastly,
calprotectin levels from fistula scrapings may help guide personalized
treatment—low levels predict success with primary surgical closure, while high
levels indicate better outcomes with additional MST.
This thesis
emphasizes the critical role of early diagnosis and the continued development
of surgical techniques and innovative therapies to improve outcomes for
patients with Crohn’s perianal fistulas. The findings support more informed
clinical decision-making and provide a foundation for future advancements in
managing this challenging condition.
