PMID- 31696918
OWN - NLM
STAT- MEDLINE
DCOM- 20210517
LR  - 20210517
IS  - 1876-4479 (Electronic)
IS  - 1873-9946 (Print)
IS  - 1873-9946 (Linking)
VI  - 14
IP  - 6
DP  - 2020 Jul 9
TI  - Ligation of the Intersphincteric Fistula Tract and Endorectal Advancement Flap 
      for High Perianal Fistulas in Crohn's Disease: A Retrospective Cohort Study.
PG  - 757-763
LID - 10.1093/ecco-jcc/jjz181 [doi]
AB  - BACKGROUND AND AIMS: Ligation of the intersphincteric fistula tract [LIFT] and 
      advancement flap [AF] procedures are well-established, sphincter-preserving 
      procedures for closure of high perianal fistulas. As surgical fistula closure is 
      not commonly offered in Crohn's disease patients, long-term data are limited. 
      This study aims to evaluate outcomes after LIFT and AF in Crohn's high perianal 
      fistulas. METHODS: All consecutive Crohn's disease patients >/=18 years old treated 
      with LIFT or AF between January 2007 and February 2018 were included. The primary 
      outcome was clinical healing and secondary outcomes included radiological 
      healing, recurrence, postoperative incontinence and Vaizey Incontinence Score. 
      RESULTS: Forty procedures in 37 patients [LIFT: 19, AF: 21, 35.1% male] were 
      included. A non-significant trend was seen towards higher clinical healing 
      percentages after LIFT compared to AF [89.5% vs 60.0%; p = 0.065]. Overall 
      radiological healing rates were lower for both approaches [LIFT 52.6% and AF 
      47.6%]. Recurrence rates were comparable: 21.1% and 19.0%, respectively. In AF a 
      trend was seen towards higher clinical healing percentages when treated with 
      anti-tumour necrosis factor/immunomodulators [75.0% vs 37.5%; p = 0.104]. Newly 
      developed postoperative incontinence occurred in 15.8% after LIFT and 21.4% after 
      AF. Interestingly, 47.4% of patients had a postoperatively improved Vaizey Score 
      [LIFT: 52.9% and AF: 42.9%]. The mean Vaizey Score decreased from 6.8 [SD 4.8] 
      preoperatively to 5.3 [SD 5.0] postoperatively [p = 0.067]. CONCLUSIONS: Both 
      LIFT and AF resulted in satisfactory closure rates in Crohn's high perianal 
      fistulas. However, a discrepancy between clinical and radiological healing rates 
      was found. Furthermore, almost half of the patients benefitted from surgical 
      intervention with respect to continence.
CI  - (c) European Crohn's and Colitis Organisation (ECCO) 2019.
FAU - van Praag, Elise M
AU  - van Praag EM
AD  - Department of Surgery, Amsterdam UMC, University of Amsterdam, Meibergdreef, 
      Amsterdam,the Netherlands.
FAU - Stellingwerf, Merel E
AU  - Stellingwerf ME
AD  - Department of Surgery, Amsterdam UMC, University of Amsterdam, Meibergdreef, 
      Amsterdam,the Netherlands.
FAU - van der Bilt, Jarmila D W
AU  - van der Bilt JDW
AD  - Department of Surgery, Amsterdam UMC, University of Amsterdam, Meibergdreef, 
      Amsterdam,the Netherlands.
FAU - Bemelman, Wilhelmus A
AU  - Bemelman WA
AD  - Department of Surgery, Amsterdam UMC, University of Amsterdam, Meibergdreef, 
      Amsterdam,the Netherlands.
FAU - Gecse, Krisztina B
AU  - Gecse KB
AD  - Department of Gastroenterology and Hepatology, Amsterdam UMC, University of 
      Amsterdam, Meibergdreef, Amsterdam, the Netherlands.
FAU - Buskens, Christianne J
AU  - Buskens CJ
AD  - Department of Surgery, Amsterdam UMC, University of Amsterdam, Meibergdreef, 
      Amsterdam,the Netherlands.
LA  - eng
PT  - Journal Article
PL  - England
TA  - J Crohns Colitis
JT  - Journal of Crohn's & colitis
JID - 101318676
RN  - 0 (Immunologic Factors)
RN  - 0 (Tumor Necrosis Factor Inhibitors)
SB  - IM
MH  - Adult
MH  - *Anal Canal/physiopathology/surgery
MH  - Crohn Disease/*complications
MH  - *Digestive System Surgical Procedures/adverse effects/methods
MH  - *Fecal Incontinence/diagnosis/etiology
MH  - Female
MH  - Humans
MH  - Immunologic Factors/therapeutic use
MH  - Ligation/adverse effects/methods
MH  - Male
MH  - Outcome and Process Assessment, Health Care
MH  - *Postoperative Complications/diagnosis/epidemiology
MH  - Prognosis
MH  - *Rectal Fistula/etiology/physiopathology/surgery
MH  - Recurrence
MH  - Risk Factors
MH  - Surgical Flaps
MH  - Tumor Necrosis Factor Inhibitors/therapeutic use
PMC - PMC7346888
OTO - NOTNLM
OT  - Crohn's disease
OT  - Perianal fistula
OT  - surgery
EDAT- 2019/11/08 06:00
MHDA- 2021/05/18 06:00
PMCR- 2019/11/07
CRDT- 2019/11/08 06:00
PHST- 2019/11/08 06:00 [pubmed]
PHST- 2021/05/18 06:00 [medline]
PHST- 2019/11/08 06:00 [entrez]
PHST- 2019/11/07 00:00 [pmc-release]
AID - 5614286 [pii]
AID - jjz181 [pii]
AID - 10.1093/ecco-jcc/jjz181 [doi]
PST - ppublish
SO  - J Crohns Colitis. 2020 Jul 9;14(6):757-763. doi: 10.1093/ecco-jcc/jjz181.