Surgical treatment of anorectal fistula in patients with Crohn's disease.

Forty-seven patients with Crohn's disease were operated upon for fistula in ano during a 22 year period with an average follow-up time of 82 months. In 29 of the patients, the fistulotomy or fistulectomy wound healed primarily; in 37, a state of complete healing or minimal disability, sometimes after multiple fistulotomies, was achieved. Five patients required proctectomy, but the need for removal of the anorectum was not caused by surgical treatment of the fistula in any instance. Of the 31 patients who had a classical internal opening at the dentate line, 23 healed primarily after surgical treatment of the fistula, compared with only seven of 16 patients without such an internal opening. The 21 patients in whom the rectum was not involved and in whom there was a classical internal opening at the dentate line were an especially favorable group: 18 of these healed primarily after surgical treatment of the fistula, and although ten of them had one or more recurrences of the fistulas, 18 ultimately achieved a state of complete healing or minimal disability. We conclude that operative treatment of fistula in ano is a safe and effective modality in a carefully selected group of patients with Crohn's disease.