Published online Oct 7, 2014. doi: 10.3748/wjg.v20.i37.13205
Revised: June 3, 2014
Accepted: July 11, 2014
Published online: October 7, 2014
Anal fistulas are a common manifestation of Crohn’s disease (CD). The first manifestation of the disease is often in the peri-anal region, which can occur years before a diagnosis, particularly in CD affecting the colon and rectum. The treatment of peri-anal fistulas is difficult and always multidisciplinary. The European guidelines recommend combined surgical and medical treatment with biologic drugs to achieve best results. Several different surgical techniques are currently employed. However, at the moment, none of these techniques appear superior to the others in terms of healing rate. Surgery is always indicated to treat symptomatic, simple, low intersphincteric fistulas refractory to medical therapy and those causing disabling symptoms. Utmost attention should be paid to correcting the balance between eradication of the fistula and the preservation of fecal continence.
Core tip: Treatment of anal fistulas in Crohn’s disease is a challenging clinical problem. Although several studies have been published, a consensus on treatment strategy has not yet been achieved. Clinical experience suggests that treatment should be determined according to the type and clinical behavior of the fistula. Asymptomatic fistulas should not be treated, while symptomatic ones could benefit from combined medical and surgical treatment. Surgery can vary from simple drainage and setonage, to more complex and sophisticated procedures. The overall aim of the surgical procedures is fistula healing without compromising fecal continence.