[Surgical management of anorectal complications in Crohn disease]

Anorectal manifestations can be expected in about 40% of all patients suffering from Crohn's disease. The frequency increases with extension of disease towards the anal canal. If the rectum is involved, they are obligatory present and contribute to the necessity of a stoma formation. Surgical indication is mostly given, especially in cases with putrid secretion. Primary aim of therapy is the control of peri-anorectal infection by excision of all the inflamed extramural tissue. Wether the underlying fistulas are excised too, depends on their topography to the sphincter system. Fistulas, running distal of the midth of the spincter, are radically excisebal and will definitely heal in over 90%. More than 60% of all fistulous anorectal manifestations belong to this type. Rectovaginal fistulas are provided with fistuloplasty, however healing conditions are problematous and healing will only be gained in about 50%. Fistulas in the upper third of the sphincter or above the sphincteric plane (rectal fistula) are managed by seton drainage of the transmural tract and complete excision of the infected tissue around, so that disease is reduced to its most simply condition. The further aim then is to derive it to cicatrous concretisation, so that infection will not expand again and patients will be free of pain. However this needs prolongation of seton drainage for at least 6 to 12 months.