Clinical trials
- Guidi L, Ratto C, Semeraro S, et al. Combined therapy with infliximab and seton drainage for perianal fistulizing Crohn's disease with anal endosonographic monitoring: a single-centre experience. Tech Coloproctol 2008; 12(2): 111-7.
This methodologically sound, prospective study has provided strong evidence for the benefit of combined use of setons and infliximab in the management of perianal sepsis in Crohn's disease.
This avoids the previous problem of healing of skin prior to obliteration of fistulous tract.
- Joyce M, Veniero JC, Kiran RP. Magnetic resonance imaging in the management of anal fistula and anorectal sepsis. Clin Colon Rectal Surg 2008; 21(3): 213-9.
Expert opinion and literature review of the role of MRI in the management of perianal sepsis.
- Malik AI, Nelson RL. Surgical management of anal fistulae: a systematic review. Colorectal Dis 2008; 10(5): 420-30.
This systematic review has integrated the evidence on the newer approaches to fistula management that have yet to reach common practice in this country. Flap repair combined with fibrin glue treatment of fistulae may increase failure rates. Radiofrequency fistulotomy produces less pain and may allow for speedier healing.
- Malik AI, Nelson RL, Tou S. Incision and drainage of perianal abscess with or without treatment of anal fistula. Cochrane Database Syst Rev 2010; 7: CD006827.
This systematic review provides evidence that fistula surgery with abscess drainage significantly reduces recurrence or persistence of abscess/fistula or the need for repeat surgery.
Guidelines
- The British Society of Gastroenterology guidelines on the management of inflammatory bowel diseases includes guidance on the medical management of fistulating perianal Crohn's disease. www.bsg.org.uk/pdf_word_docs/ibd.pdf
- Phillips RKS. Colorectal surgery: a companion to specialist surgical practice 2009. Saunders WB.
Curriculum
The RCGP covers this topic in statement 15.2 of the RCGP curriculum, Digestive problems
Online
- Patient UK. Anorectal abscess www.patient.co.uk/doctor/Ano-rectal-Abscess.htm Information and advice for doctors.
- NHS Clinical Knowledge Summaries www.cks.nhs.uk/patient_information_leaflet/anal_fistula A well-structured and understandable patient information leaflet. www.cks.nhs.uk/crohns_disease/management/scenario_suspected_crohns_disease/suspecting_crohns_disease Key reading to develop understanding of when to suspect Crohn's disease and how to make the diagnosis.
Contributed by Miss Sophie-Anne Welchman, a specialist surgical registrar, Derriford Hospital, Plymouth, Devon
