Surgical management of perianal fistulizing Crohn's Disease

Crohn's Disease (CD) is a chronic inflammatory bowel disease characterized by recurring symptoms that can result in bowel damage and long-term disability. It is crucial to achieve early diagnosis and appropriate treatment. Perianal manifestations are common in 20%-54% of Crohn's disease patients, with fistulas being the primary symptom in 10%. The presence of perianal Crohn's disease can occur before or after initial diagnosis and is associated with higher postoperative recurrence, surgical intervention, and shorter recurrence times. Other signs of severe disease include smoking, persistent symptoms, frequent flare-ups, emergence of lesions, steroid treatment, and surgery. Around 20% of patients have additional disease areas in the small bowel or ileocolic region (2). Perianal Crohn's disease significantly impacts patients' health and presents significant challenges for healthcare professionals. Perianal Crohn's disease, a common cause of perianal lesions, often presents as perirectal/perianal fistula, with over half of patients having multiple lesions. However, symptoms often lack correlation with objective assessment methods like endoscopy, cross-sectional imaging, or noninvasive biomarkers. Accurate evaluation of fistulae can be achieved through the use of Contrast-enhanced magnetic resonance imaging, endosonography, and examination under anesthesia (EUA). These methods enable the distinction between simple perianal fistulae and complex fistulae. Perianal CD fistulas can be simple or complex, with simple fistulas having a single external opening and low lesion. Individuals with CD are more likely to develop complex fistulizing disease, which presents significant treatment challenges.......