General Surgery Department, La Paz University Hospital, Paseo de la Castellana, 261 28046, Madrid, Spain.
Gastroenterology Department, La Paz University Hospital, Madrid, Spain.
Langenbecks Arch Surg. 2021 Jun;406(4):1181-1188. doi: 10.1007/s00423-021-02100-4. Epub 2021 Jan 30.
As one of the clinical manifestations of inflammatory bowel disease (IBD), perianal fistula disease (PFD) can potentially impact the patient quality of life. The management of PFD employs a multidisciplinary approach which includes antibiotics, biological therapies, immunomodulators, and surgery. We analyzed the outcome and prognostic factors of anal fistula surgery in IBD patients.
We conducted a retrospective study of IBD patients undergoing elective surgery for anal fistula between January 2015 and December 2018 at our University Department of Surgery. We collated demographic factors, disease activity, imaging (MRI and endoanal ultrasound), surgical interventions, and medical treatment assessing the rate of fistula closure and fecal incontinence, 2 months and 1 year after surgery.
Thirty-five IBD patients with anal fistula underwent surgery (28 Crohn's disease, four ulcerative colitis, and three indeterminate colitis). Twenty-seven patients presented with complex fistulas and eight with simple fistulas with 10 patients undergoing single-stage surgery. In 25 patients, a two-stage surgical approach was planned and performed (draining seton plus medical treatment and then second-stage surgery with curative intent). At 1 year of follow-up, the fistula healing rate was 50% for single-stage surgery and 60% for two-stage surgery (P = 0.09). Overall, 19.2% of patients developed postoperative fecal incontinence. A time interval greater than 12 months between surgeries is a favorable prognostic factor for fistula healing with the two-stage approach (P = 0.002).
In our retrospective study, two-stage surgery in IBD patients presenting with complex perianal fistulous disease results in a better medium-term outcome with a longer time interval between surgeries.
肛旁瘘疾病（PFD）作为炎症性肠病（IBD）的临床表现之一，可能会影响患者的生活质量。PFD 的治疗采用多学科方法，包括抗生素、生物疗法、免疫调节剂和手术。我们分析了 IBD 患者肛旁瘘手术的结果和预后因素。
我们对 2015 年 1 月至 2018 年 12 月在我们大学外科系接受择期肛旁瘘手术的 IBD 患者进行了回顾性研究。我们整理了人口统计学因素、疾病活动度、影像学（MRI 和腔内超声）、手术干预和医疗治疗，评估了手术后 2 个月和 1 年的瘘管闭合和粪便失禁发生率。
35 例 IBD 患者行肛旁瘘手术（28 例克罗恩病，4 例溃疡性结肠炎，3 例未定型结肠炎）。27 例患者表现为复杂瘘管，8 例患者表现为简单瘘管，10 例患者行单阶段手术。25 例患者计划并实施了两阶段手术（引流挂线加药物治疗，然后行二期有治愈意图的手术）。在 1 年的随访中，单阶段手术的瘘管愈合率为 50%，两阶段手术的愈合率为 60%（P = 0.09）。总的来说，19.2%的患者术后出现粪便失禁。两阶段手术中两次手术之间的时间间隔大于 12 个月是瘘管愈合的有利预后因素（P = 0.002）。
在我们的回顾性研究中，对患有复杂肛旁瘘疾病的 IBD 患者采用两阶段手术可获得更好的中期结果，且两次手术之间的时间间隔更长。
