M Kraemer1, A Kirschmeier, T Marth. 1. Abteilung Allgemeine und Viszeralchirurgie, Koloproktologie, St. Barbara-Klinik Hamm-Heessen GmbH, Am Heessener Wald 1, 59073 Hamm, Germany. mkraemer@barbaraklinik.de
Abstract
PURPOSE: Infliximab may represent an adjuvant to surgical therapy in patients with severe anal Crohn's disease as it has been shown to affect rapid remissions in a proportion of cases. PATIENTS AND METHODS: Nineteen patients underwent infliximab therapy 5 mg/kg perioperatively to scheduled anal reconstructive surgery for complicated fistulising anal Crohn's disease. RESULTS: One adverse event was recorded (generalised exanthema with subsequent resolution). Eight patients showed complete clinical remission refusing further surgery. One of the eight relapsed during follow-up and was continued on infliximab. Surgery consisted of advancement flaps. It was successful at first attempt in nine of the remaining 11 patients (82%). Operative fistula closure remained unsuccessful in two patients. Overall, 16 of 19 patients (84%) with advanced anal Crohn's disease had a favourable outcome. CONCLUSION: The use of infliximab as adjuvant to surgery in this series of patients with complicated anal Crohn's disease was safe. Although the data is uncontrolled a positive effect of infliximab on the outcome of surgery may be postulated since our results compare favourably with other studies.
PURPOSE:Infliximab may represent an adjuvant to surgical therapy in patients with severe anal Crohn's disease as it has been shown to affect rapid remissions in a proportion of cases. PATIENTS AND METHODS: Nineteen patients underwent infliximab therapy 5 mg/kg perioperatively to scheduled anal reconstructive surgery for complicated fistulising anal Crohn's disease. RESULTS: One adverse event was recorded (generalised exanthema with subsequent resolution). Eight patients showed complete clinical remission refusing further surgery. One of the eight relapsed during follow-up and was continued on infliximab. Surgery consisted of advancement flaps. It was successful at first attempt in nine of the remaining 11 patients (82%). Operative fistula closure remained unsuccessful in two patients. Overall, 16 of 19 patients (84%) with advanced anal Crohn's disease had a favourable outcome. CONCLUSION: The use of infliximab as adjuvant to surgery in this series of patients with complicated anal Crohn's disease was safe. Although the data is uncontrolled a positive effect of infliximab on the outcome of surgery may be postulated since our results compare favourably with other studies.
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