[New methods of treatment of perianal fistula in Crohn disease. Long-term results in 81 patients].

Surgical treatment of anal fistulas was carried out on 103 patients with Crohn's disease (49 men and 54 women). The patients were between 9 and 72 years of age with an average of 35 years. A new operative technique is briefly presented: the main fistulous tract is excised out of the sphincter (muscle), proceeding from a wide excision made around the external opening. Meticulous core is taken to limit the loss of muscle tissue. The resulting opening within the anal canal is closed transanally as well as externally, using two or three layers of sutures, partly to prevent contamination and partly to speed up healing. Secondary tracts are drained and be granulations removed with a sharp spoon. The follow-up of 81 patients over a period of 4.8 years uncovered fistula recurrence in 17 cases. Of these patients, 15 had a recurrence within the abdomen, necessitating hospitalization. A high recurrence rate of 26% occurred in those patients where the disease was already present in the rectum. By comparison the recurrence rate was only 14% when the disease was otherwise limited to the terminal ileum. Rectovaginal fistulas exhibited the highest recurrence rate of 27.2%. Manometric measurements in 22 patients exhibited a shortening of the anal canal from 2.52 +/- 0.42 cm over and against 2.83 +/- 0.64 cm. There was also a reduction of the maximum voluntary pressure of 165 +/- 35 cm H2O compared with 200 +/- 39 cm H2O (P less than 0.01). These patients were compared with patients with Crohn's disease without manifestation of perianal fistula. None of the patients operated on exhibited incontinence for a firm bowel movement.