O D Faiz

Symptom Amelioration in Crohn’s Perianal Fistulas Using Video-Assisted Anal Fistula Treatment (VAAFT)

MethodsnConsecutive patients with complex Crohns fistula undergoing a VAAFT for symptomatic Crohns anal fistula were included. They were identified from a prospectively maintained database, which was interrogated from June 2015-November 2017. Patients underwent diagnostic fistuloscopy and fulguration of tracts/secondary extensions. Setons were sited/replaced after the procedure to maintain postoperative drainage. Primary endpoint was completion of the Measure your medical outcome profile (MYMOP2) quality of life (QoL) questionnaire at 6 weeks postoperatively. Secondary outcome measures were a decisional regret scale (DRS), post-operative complications and the thirty-day re-operation rate.nnnResultsn25 patients underwent the procedure during the study period. 21/25 patients (84%) completed MYMOP2 QoL data demonstrating a statistically significant improvement in both pain and discharge scores. 81% of patients who completed the agreed/strongly agreed that the procedure was right decision and no patient regretted undergoing the procedure. There was 1 reoperation but otherwise no complications.nnnConclusionsnThis study demonstrates feasibility, safety and importantly an improvement in patient reported outcomes in a series of patients undergoing VAAFT for complex Crohns anal fistula. VAAFT reduces the main symptoms (pain and discharge) in patients with complex refractory anal fistulas.

Management of Perianal Crohn’s Disease in the Biologic Era

Perianal Crohn’s disease represents a distinct, aggressive phenotype of Crohn’s disease associated with increased morbidity. It encompasses a variety of manifestations including perianal fistula which has a very significant on patient’s quality of life. Anti-TNF therapy has heralded a change in the management of these patients and a combination of medical and surgical treatment is required for most perianal manifestations. A multidisciplinary approach involving gastroenterologists, surgeons, radiologists, IBD nurse specialists and dieticians, and an understanding of all forms of perianal Crohn’s disease and options for treatment are crucial to minimise the often disabling morbidity that can potentially effect this group of patients.