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Title: Effectiveness of combined surgical and biological treatment of perianal fistulizing Crohn’s disease


Introduction. Perianal fistulas are present in 20-40% of Crohn’s patients, causing great discomfort and significant compromising quality of life. Biologic therapy showed highest success rate in the treatment of fistulizing Crohn’s disease. Aim of study. To estimate efficacy of combined surgical and biological treatment of fistulizing perianal Crohn’s disease. Material and methods. 34 patients with confirmed perianal, fistulizing Crohs’s disease were operated in the IIIrd Department of general Surgery between 2007 and 2009. 21 patients underwent biological treatment with anti-TNF-α antibodies. 13 remaining patients were included to the control group. Every patient from both study and control group underwent fistulography, rectoscopy and endorectal ultrasound examination (ERUS). EUA with excision of external orifice and fistulectomy with non-cuting seton placement were done. Afterwards patients, which fulfilled the inclusion criteria were included to biologic treatment with infliximab. The ssessments were after 0, 6, 10, 30 and 54 weeks. Results. After 54 weeks of combined modality treatment, closing of 76,1% draining perianal fistulas was observed in study group, while in control group only 36,3% (p<0,01). During further follow-up, significant higher reduction of CDAI, PDAI, CRP level was observed (p<0,05). Correlation of CDAI and CRP was proved (p<0,05), esp ; ecially after 10 and 54 weeks. Statistically significant increase of BMI and TLC was affirmed at study (p<0,05). The recurrence rate in control group after 30 weeks was 19,8 %, and was higher after 54 weeks: 27,4 %. After combined treatment recurrence rate was significantly lower (3,2%; p<0,01). Conclusions. Combined, surgical and biological treatment of Crohn’s perianal fistulas is characterized by highest efficiency and it allows achieving better clinical results and highest percentage of fistulas closing. Furthermore surgical excision and debridement with non-cuting setons placement establish better condition for effective healing of fistulas tracts allow decreasing the recurrence rate and complication.

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2 - studia doktoranckie

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Wydział Lekarski


Herman, Roman

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Mar 14, 2023

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Jun 27, 2022

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Edition name Date
ZB-114713 Mar 14, 2023


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