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Fistula Tract Transposition for Extrasphincteric Perianal Fistulae in Crohn's Disease.
Antonio Baldin*
Surgery, University Federal of Parana - Brazil, Curitiba, PR, Brazil
Introduction: Perianal fistulas in patients with Crohns disease are usually multiple, complex, and hard to treat. Fistulotomy and fistulectomy are the techniques most commonly used, but are associated to significant recurrence rates and sphincter damage. Fistula track transposition has rarely been used to treat Crohn's perianal fistulae and has the potential to reduce reccurence and incontinence rates. The aim of this study is to report results obtained with the use of fistula tract transposition for a group of selected patients with Crohn's Disease and complex extrasphincteric perianal fistulae.
Methods: Retrospective review of results obtained in selected patients with Crohn's Disease and complex extrasphincteric perianal fistulae treated with fistula track transposition. The technique consists in dissecting and medially transposing the fistula tract into the intersphincteric plane, aimed at involving a smaller internal sphincter segment into an intersphincteric position. The internal and external orifice stay close and a second treatment is planned with a simple fistulotomy to preserve the anal continence.
Results: Five patients were treated in between December/2013 and March/2015. Four patients were male. Median age was 43,6 (range 32-56) years. Three of them were under combined terapy with azatioprine and biological drugs and two were under isolated biological therapy. Four patients have already been submited to perianal fistula repair with seton and one had a recto-vaginal fistula. At a median follow-up of 15,2 months (range 9-23), only one patient had a recurrence, associated with a new tract formation. All patients remained continent.
Conclusion: Fistula transposition seems to be a appropriate surgical alternative for selected patients with Crohn's Disease and complex extrasphincteric perianal fistulae; and may decreases recurrence rates and the risk of anal incontinence. Larger series with longer follow-up are needed to confirm our results.
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