Selective surgical management of Crohn's disease of the anus

To establish specific indications for the surgical treatment of perianal Crohn's disease, the authors report their experience with 102 patients (45%) with these lesions in a series of 225 patients with small- and large-bowel Crohn's disease. Ulcerations or fissures were present in 50%, abscesses developed in 32% and fistulas in 53%. More than one type of lesion was present in 59%. One of six patients had no symptoms, in one of five the lesion was etiologically independent of Crohn's disease and one of four patients did not require surgical intervention. Severe pain indicated an abscess that required drainage, and 57% of patients who underwent drainage alone or with an added seton later required fistulotomy to become symptom-free. Primary fistulotomy for abscess achieved complete healing in 71% of cases and fistulotomy also healed in 60% of chronic fistulas for a combined fistulotomy healing rate of 63% when anal Crohn's disease was present and 68% in all patients with Crohn's disease. Anal dilatations with bougies were effective in short stenoses which were present in 7% of cases. Twelve percent of patients required excision of the rectum to be relieved of their symptoms.