PMID- 27423057
OWN - NLM
STAT- MEDLINE
DCOM- 20170912
LR  - 20220318
IS  - 1463-1318 (Electronic)
IS  - 1462-8910 (Linking)
VI  - 19
IP  - 3
DP  - 2017 Mar
TI  - Surgical management of fistulating perianal Crohn's disease: a UK survey.
PG  - 266-273
LID - 10.1111/codi.13462 [doi]
AB  - AIM: Around one-third of patients with Crohn's disease are affected by Crohn's 
      fistula-in-ano (pCD). It typically follows a chronic course and patients undergo 
      long-term medical and surgical therapy. We set out to describe current surgical 
      practice in the management of pCD in the UK. METHOD: A survey of surgical 
      management of pCD was designed by an expert group of colorectal surgeons and 
      gastroenterologists. This assessed acute, elective, multidisciplinary and 
      definitive surgical management. A pilot of the questionnaire was undertaken at 
      the 2015 meeting of the Digestive Disease Federation. The survey was refined and 
      distributed nationally through the trainee collaborative networks. RESULTS: 
      National rollout obtained responses from 133 of 179 surgeons approached (response 
      rate 74.3%). At first operation, 32% of surgeons would always consider drainage 
      of sepsis and 31.1% would place a draining seton. At first elective operation, 
      66.6% would routinely insert of draining seton, and 84.4% would avoid cutting 
      seton. An IBD multidisciplinary team was available to 87.6% of respondents, 
      although only 25.1% routinely discussed pCD patients. Anti-tumour necrosis 
      factor-alpha therapy was routinely considered by 64.2%, although 44.2% left 
      medical management to gastroenterologists. Common definitive procedures were 
      removal of the seton only (70.7%), fistulotomy (57.1%), advancement flap (38.9%), 
      fistula plug (36.4%) and ligation of intersphincteric track (LIFT) procedure 
      (31.8%). Indications for diverting stoma or proctectomy were intractable sepsis, 
      incontinence and poor quality of life. CONCLUSION: This survey has demonstrated 
      areas of common practice, but has also highlighted divergent practice including 
      choices of definitive surgery and multimodal management. Practical guidelines are 
      required to support colorectal surgeons in the UK.
CI  - Colorectal Disease (c) 2016 The Association of Coloproctology of Great Britain and 
      Ireland.
FAU - Lee, M J
AU  - Lee MJ
AUID- ORCID: 0000-0001-9971-1635
AD  - Department of General Surgery, Sheffield Teaching Hospitals, Sheffield, UK.
AD  - Department of Oncology and Metabolism, Medical School, University of Sheffield, 
      Sheffield, UK.
AD  - South Yorkshire Surgical Research Group, Department of General Surgery, Northern 
      General Hospital, Sheffield, UK.
FAU - Heywood, N
AU  - Heywood N
AD  - University Hospital South Manchester, Manchester, UK.
AD  - North-West Research Collaborative, University Hospital South Manchester, 
      Manchester, UK.
FAU - Sagar, P M
AU  - Sagar PM
AD  - St James University Hospital, Leeds, UK.
FAU - Brown, S R
AU  - Brown SR
AD  - Department of General Surgery, Sheffield Teaching Hospitals, Sheffield, UK.
FAU - Fearnhead, N S
AU  - Fearnhead NS
AD  - Addenbrooke's Hospital, Cambridge, UK.
CN  - pCD Collaborators
LA  - eng
PT  - Journal Article
PL  - England
TA  - Colorectal Dis
JT  - Colorectal disease : the official journal of the Association of Coloproctology of 
      Great Britain and Ireland
JID - 100883611
RN  - 0 (Anti-Bacterial Agents)
RN  - 0 (Tumor Necrosis Factor-alpha)
SB  - IM
MH  - Anti-Bacterial Agents/therapeutic use
MH  - Colorectal Surgery/*methods
MH  - Colostomy/statistics & numerical data
MH  - Crohn Disease/complications/*therapy
MH  - Drainage/statistics & numerical data
MH  - Elective Surgical Procedures
MH  - Fecal Incontinence/etiology
MH  - Gastroenterology
MH  - Humans
MH  - Intestinal Fistula/therapy
MH  - Practice Patterns, Physicians'
MH  - Prosthesis Implantation/statistics & numerical data
MH  - Quality of Life
MH  - Rectal Fistula/etiology/*therapy
MH  - Sepsis/etiology
MH  - Surgical Flaps/statistics & numerical data
MH  - Surveys and Questionnaires
MH  - Tumor Necrosis Factor-alpha/antagonists & inhibitors
MH  - United Kingdom
OTO - NOTNLM
OT  - Crohn's disease
OT  - anal fistula
OT  - survey
FIR - Abbas, A
IR  - Abbas A
FIR - Adegbola, S
IR  - Adegbola S
FIR - Alfa-Wali, M
IR  - Alfa-Wali M
FIR - Ashken, L
IR  - Ashken L
FIR - Barrow, P
IR  - Barrow P
FIR - Brady, R R
IR  - Brady RR
FIR - Couch, D
IR  - Couch D
FIR - Engledow, A
IR  - Engledow A
FIR - Gammeri, E
IR  - Gammeri E
FIR - Gill, M
IR  - Gill M
FIR - Kadhum, M
IR  - Kadhum M
FIR - Kankam, H
IR  - Kankam H
FIR - Kaptanis, S
IR  - Kaptanis S
FIR - Labib, P
IR  - Labib P
FIR - Luck, J
IR  - Luck J
FIR - Majid, K
IR  - Majid K
FIR - Martin, J
IR  - Martin J
FIR - Moss, A
IR  - Moss A
FIR - Nicholson, J
IR  - Nicholson J
FIR - Iqbal, M R
IR  - Iqbal MR
FIR - Singh, B
IR  - Singh B
FIR - Sengupta, N
IR  - Sengupta N
FIR - Sproson, C
IR  - Sproson C
FIR - Stubbs, B
IR  - Stubbs B
FIR - Suker, F
IR  - Suker F
FIR - Tozer, P
IR  - Tozer P
FIR - van Boxel, G
IR  - van Boxel G
FIR - Ventham, N
IR  - Ventham N
EDAT- 2016/07/17 06:00
MHDA- 2017/09/13 06:00
CRDT- 2016/07/17 06:00
PHST- 2016/04/27 00:00 [received]
PHST- 2016/06/08 00:00 [accepted]
PHST- 2016/07/17 06:00 [pubmed]
PHST- 2017/09/13 06:00 [medline]
PHST- 2016/07/17 06:00 [entrez]
AID - 10.1111/codi.13462 [doi]
PST - ppublish
SO  - Colorectal Dis. 2017 Mar;19(3):266-273. doi: 10.1111/codi.13462.