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Crohn, fistula and stoma

S Korsun, G Liebig-Hoerl, A Fuerst
BACKGROUND: The aim of this study was to evaluate the effectiveness of gracilis muscle transposition (GMT) to treat recurrent anovaginal, rectovaginal, rectourethral, and pouch-vaginal fistulas in patients with inflammatory bowel disease (IBD). METHODS: A retrospective study was conducted in patients with IBD who had GMT performed by a single surgeon between 2000 and 2018. Follow-up data regarding healing rate, complications, additional procedures, and stoma closure rate was collected...
January 2019: Techniques in Coloproctology
Elisabeth Hain, Léon Maggiori, Marion Orville, Xavier Tréton, Yoram Bouhnik, Yves Panis
Background & Aims: Faecal diversion (FD) can be proposed in patients with refractory anoperineal Crohn's disease (APCD). This study aimed to assess long-term results of this strategy, following the advent of the anti-TNF era. Methods: All patients who underwent FD for refractory APCD between 2005 and 2017 were included, excluding patients with a history of ileal pouch-anal anastomosis. A multivariate analysis regarding absence of stoma reversal (SR) was performed...
November 19, 2018: Journal of Crohn's & Colitis
Shaji Sebastian, Christopher Black, Daniela Pugliese, Alessandro Armuzzi, Kapil Sahnan, Soad M Elkady, Kostas H Katsanos, Demitrios K Christodoulou, Christian Selinger, Giovanni Maconi, Nicola S Fearnhead, Uri Kopylov, Yana Davidov, Marta M Bosca-Watts, Pierre Ellul, Martina Muscat, Konstantinos Karmiris, Ailsa L Hart, Silvio Danese, Shomron Ben-Horin, Gionata Fiorino
BACKGROUND: Treatment paradigms for Crohn's disease with perianal fistulae (CD-pAF) are evolving. AIMS: To study the impact of multimodality treatment in CD-pAF on recurrence rates and the need for re-interventions and to identify predictive factors for these outcomes. METHODS: This was a multinational multicentre retrospective cohort study. Multimodality approach was defined as using a combination of medical treatments (anti-TNFs ± immunomodulators ± antibiotics) along with surgical approach (examination under anaesthesia (EUA) ± seton drainage) at diagnosis of CD-pAF...
September 18, 2018: Alimentary Pharmacology & Therapeutics
Romano Schneider, Marko Kraljević, Markus von Flüe, Ida Füglistaler
Introduction: Rectal mucoceles rarely occur and only a few cases are described in the literature. They usually appear after subtotal colectomy or Hartmann procedure originating from persisting rectal mucus production and simultaneous stenosis of the anal canal. Case Presentation: A 74-year-old female patient presented with the feeling of an abdominal growing mass. Complex medical history included a subtotal colectomy with an end ileostomy and a mucous fistula at the descending colon due to Crohn disease at the age of 16 years...
January 2018: Case Reports in Gastroenterology
Zhen Guo, Xingchen Cai, Ruiqing Liu, Jianfeng Gong, Yi Li, Lei Cao, Weiming Zhu
Background/Aims: Resection of the diseased segment and suture of the victim segment is recommended for enteroenteric fistula in Crohn's disease (CD). The main difficulty in this procedure remains reliable diagnosis of the victim segment, especially for fistulas found intraoperatively and inaccessible on endoscopic examination. We aimed to explore whether intraoperative inspection alone is reliable. Methods: Patients undergoing conservative surgery between 2011 and 2016 for enteroenteric fistulas complicating CD were identified from a prospectively maintained database...
April 2018: Intestinal Research
Charlène Brochard, Amandine Landemaine, Alexandre Merlini L'Heritier, Marie Provost Dewitte, Belinda Tchoundjeu, Tanguy Rohou, Aurélien Garros, Guillaume Bouguen, Laurent Siproudhis
Background & Aims: The European Crohn's and Colitis Organization recommends magnetic resonance imaging (MRI) of anal fistulas to decide on the drug/surgery strategy. No evidence is available on the long-term impact of MRI features on fistula healing. The aim of this study was to evaluate the benefit of combined drug/surgery strategies for the treatment of perianal Crohn's fistulas based on MRI factors at referral. Methods: The clinical event (anal abscess, new fistula tract, cellulitis), therapeutic intervention (introduction/optimization of immunosuppressant/biologics, anal surgery, intestinal resection, stoma), and MRI data were prospectively recorded for patients with Crohn's disease (CD) and anal fistulas...
June 8, 2018: Inflammatory Bowel Diseases
Hugo Palma Rios, André Goulart, Pedro Leão
INTRODUCTION: Performing surgery on patients with Crohn's disease is a true challenge due to the elevated risk of complications related to the chronic proinflammatory response. Stenosis is the leading cause of intestinal resection in these patients. CASE REPORT: The authors present the case of a 50-year-old woman with inflammatory stenosis of the terminal ileum due to Crohn's disease. The patient underwent a laparoscopic ileocecal resection, which was complicated by a small anastomotic dehiscence with localized peritonitis...
January 2018: Wounds: a Compendium of Clinical Research and Practice
Wanjin Shao
Rectovaginal fistulas are distressing conditions to patients and present a therapeutic challenge to surgeons. Whether the etiology of the fistula is obstetric, Crohn's disease-related, or cryptoglandular, a thorough anatomy evaluation is required in order to select the correct repair. No single surgical technique is suitable for all rectovaginal fistulas as of now. Less invasive surgery should be selected in primary repair, and endorectal advancement flap repair was recommended as the first line therapy in most guidelines for the treatment of rectovaginal fistulas...
December 25, 2016: Zhonghua Wei Chang Wai Ke za Zhi, Chinese Journal of Gastrointestinal Surgery
M Martí-Gallostra, P Myrelid, N Mortensen, S Keshav, S P L Travis, B George
OBJECTIVE: A defunctioning stoma is a therapeutic option for colonic or perianal Crohn's disease. In the pre-biologic era the response rate to defunctioning in our unit was high (86%), but intestinal continuity was only restored in 11-20%. Few data exist on the outcome of defunctioning since the widespread introduction of biologicals. MATERIAL AND METHODS: All patients undergoing a defunctioning stoma for colonic/perianal Crohn's disease since 2003-2011 were identified from a prospective database...
March 2017: Scandinavian Journal of Gastroenterology
Lori Robbins, Karen Zaghiyan, Gil Melmed, Eric Vasiliauskas, Shahzad Ahmed, Dermot McGovern, Shervin Rabizadeh, Namita Singh, Carol Landers, Andrew Ippoliti, David Shih, Stephan Targan, Phillip Fleshner
BACKGROUND AND AIMS: A subset of patients who undergo ileal pouch-anal anastomosis [IPAA] for ulcerative colitis [UC] will later be diagnosed with denovo Crohn's disease [CD]. These patients have a higher risk of pouch failure. In this study we evaluated inflammatory bowel disease [IBD] serology in patients with denovo CD and examined the success of anti-tumour necrosis factor-alpha [anti-TNFα] therapy in preventing ileostomy in denovo CD patients who failed anti-TNFα therapy before IPAA...
January 2017: Journal of Crohn's & Colitis
M J Lee, N Heywood, P M Sagar, S R Brown, N S Fearnhead
AIM: Around one-third of patients with Crohn's disease are affected by Crohn's fistula-in-ano (pCD). It typically follows a chronic course and patients undergo long-term medical and surgical therapy. We set out to describe current surgical practice in the management of pCD in the UK. METHOD: A survey of surgical management of pCD was designed by an expert group of colorectal surgeons and gastroenterologists. This assessed acute, elective, multidisciplinary and definitive surgical management...
March 2017: Colorectal Disease: the Official Journal of the Association of Coloproctology of Great Britain and Ireland
Gisele Aaltonen, Ilona Keränen, Monika Carpelan-Holmström, Ritja Savolainen, Riikka Lindén, Anna Lepistö
AIMS: The present study compares preoperative magnetic resonance enterography (MRE) accuracy in diagnosing stenoses, abscesses and fistulas to intraoperative findings in Crohn's disease patients, and determines whether discordance between these methods alter surgical plans. METHODS: Our study included 55 consecutive patients scheduled for elective surgery due to Crohn's disease in a single institution between January 2011 and May 2015, whose surgical findings were also compared to preoperative MREs...
2017: Digestive Surgery
S Killeen, J Gunn, J Hartley
AIM: The medical management of inflammatory bowel disease (IBD) in pregnancy and the puerperium is well defined. Data on surgical management of complicated IBD in this setting are lacking. This study aimed to determine the optimal surgical strategy for medically refractory IBD during pregnancy and the puerperium. METHOD: Three databases were systematically reviewed to identify all published series or case reports of women undergoing surgery for Crohn's disease (CD) or ulcerative colitis (UC) while pregnant or during the puerperium...
February 2017: Colorectal Disease: the Official Journal of the Association of Coloproctology of Great Britain and Ireland
Rahul Narang, Tracy Hull, Steven Perrins, Jose Sebastian Garcia, Steven D Wexner
BACKGROUND: Rectovaginal fistula in Crohn's disease is challenging for both healthcare providers and patients. The impact of immunomodulation therapy on healing after surgery is unclear. OBJECTIVE: The purpose of this study was to examine whether immunomodulation therapy impacts healing after surgery for rectovaginal fistula in Crohn's disease. DESIGN: This was a retrospective analysis with a follow-up telephone survey. SETTINGS: The study was conducted at two major tertiary referral centers...
July 2016: Diseases of the Colon and Rectum
Ricardo Tadayoshi Akiba, Fabio Gontijo Rodrigues, Giovanna da Silva
Management of complex perineal fistulas such as high perianal, rectovaginal, pouch-vaginal, rectourethral, or pouch-urethral fistulas requires a systematic approach. The first step is to control any sepsis with drainage of abscess and/or seton placement. Patients with large, recurrent, irradiated fistulas benefit from stoma diversion. In patients with Crohn's disease, it is essential to induce remission prior to any repair. There are different approaches to repair complex fistulas, from local repairs to transperineal and transabdominal approaches...
June 2016: Clinics in Colon and Rectal Surgery
D Mege, M Frasson, L Maggiori, Y Panis
AIM: Many surgical techniques are available for the treatment of rectovaginal fistula (RVF). There is hitherto little information on its treatment by biological mesh interposition. The aim of the present study was to analyse our results of RVF treatment using biological mesh interposition. METHOD: Patients with RVF undergoing biological mesh interposition were identified. Success was defined by the absence of a diverting stoma and/or any vaginal discharge of faeces, flatus or mucous discharge...
February 2016: Colorectal Disease: the Official Journal of the Association of Coloproctology of Great Britain and Ireland
Helene Corte, Leon Maggiori, Xavier Treton, Jeremie H Lefevre, Marianne Ferron, Yves Panis
OBJECTIVES: The aim of this study was to assess results of surgery for rectovaginal fistula (RVF) and prognostic factors for success. BACKGROUND DATA: Management of RVF remains challenging and numerous surgical options are available. Few large reports of RVF are available and success prognostic factors remain unknown. METHODS: All patients operated for RVF from 1996 to 2014 were included. RESULTS: Seventy-nine patients presented RVF due to Crohn disease in 34 (43%), postoperative in 25 (32%), obstetrical in 7 (9%), radiation proctitis in 4 (5%), and miscellaneous in 9 (11%)...
November 2015: Annals of Surgery
M D Kjaer, J Kjeldsen, N Qvist
BACKGROUND AND AIMS: Development of a pouch-related fistula tract is an uncommon but highly morbid complication to restorative proctocolectomy with ileal pouch-anal anastomosis. Pouch failure with permanent ileostomy is reported in 21%-30% of patients, yet the factors contributing to pouch excision remain poorly defined. The aim of this study was to determine the incidence and treatment results of complicated pouch-related fistula, as well as to evaluate factors involved in excision after pouch failure...
September 2016: Scandinavian Journal of Surgery: SJS
Matthias Kraemer, David Kara
PURPOSE: Entero-vesical or entero-vaginal fistulae (EVF) are an uncommon septic complication mainly of diverticular disease. The fistulae are usually situated within extensive and dense inflammatory masses occluding the entrance of the pelvis. There are still some controversies regarding laparoscopic feasibility and treatment modalities of this disorder. METHODS: A retrospective chart review of all patients with EVF operated at our department since 2008. Patients were identified by use of the computerized hospital information system...
January 2016: International Journal of Colorectal Disease
Cristina B Geltzeiler, Kyle D Hart, Kim C Lu, Karen E Deveney, Daniel O Herzig, Vassiliki L Tsikitis
INTRODUCTION: Although medical management of Crohn's disease has changed in recent years, it is unclear whether surgical management has altered. We examined rate changes of surgical interventions, stoma constructions, and subset of ileostomy and colostomy constructions. MATERIALS AND METHODS: We reviewed the Nationwide Inpatient Sample database from 1988 to 2011. We examined the number of Crohn's-related operations and stoma constructions, including ileostomies and colostomies; a multivariable logistic regression model was developed...
October 2015: Journal of Gastrointestinal Surgery: Official Journal of the Society for Surgery of the Alimentary Tract
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