Perianal involvement is identified in one-third of patients with Crohn’s disease, including fistulas, fissures and skin tags. Perianal Crohn´s disease (PCD) is associated with decreased quality of life, due to… Click to show full abstract
Perianal involvement is identified in one-third of patients with Crohn’s disease, including fistulas, fissures and skin tags. Perianal Crohn´s disease (PCD) is associated with decreased quality of life, due to significant physical and psychologic symptoms. Video-assisted anal fistula treatment [VAAFT] is a minimally invasive surgical technique for anal fistulas, accessing primary and secondary fistula tracks for drainage and fulguration of inflammatory tissue. Our study reports the use of VAAFT for management of PCD fistulas along with medical therapy, aiming to improve symptoms and promote healing. A single-center prospective study was conducted in consecutive patients with symptomatic PCD fistulas submitted to VAAFT, from January 2020 to January 2024. The surgical procedure involved an perianal exam under analgesia and VAAFT for fistuloscopy and cauterization of fistula tracks, with setons installation and\or replacement in order to maintain postoperative drainage. The primary endpoint was completion of the ‘Perianal Disease Activity Index (PDAI)’ questionnaire at 8 weeks postoperatively. Secondary outcome measure was ´IBDQol´ questionnaire at 8 weeks postoperatively, postoperative complications and the 30-day re-operation rate. Thirty-nine patients underwent VAAFT procedure for PCD during the study period. In total, 34/39 patients [87%] provided PDAI data, demonstrating a statistically significant improvement in scores of discharge, pain and sexual activity scores. In total, 34/39 patients [87%] provided IBDQol data, demonstrating a statistically significant improvement. The only complication was sepsis in one female 28-year old patient at the immediate postoperative period, successfully managed with clinical treatment in intensive care unit. There was no re-operation in 30-day period. Our study demonstrates the feasibility, safety and importantly an improvement in patient-reported outcomes of patients undergoing VAAFT for management of PCD fistulas. VAAFT reduced the symptoms of discharge and paiin patients with complex refractory PCD fistulas.