Surgical options in the management of perianal Crohn's disease

Perianal complications of Crohn's disease are common, and surgical management has been controversial. Over the last 10 years, improved outcomes have defined a more prominent role for operative interventions, especially with respect to management of focal perineal sepsis and fistulas. Liberal placement of drainage catheters and noncutting setons, advancement flap closure of perineal fistulas, and selective construction of diverting stomas have good results when combined with optimal medical therapy to induce remission of inflammation. Proctectomy, which is infrequently required, can often be postponed for several years when complementary surgical and medical treatments are provided.