What is the optimal surgical strategy for complex perianal fistulous disease in pediatric Crohn's disease? A systematic review.

Abstract:

PURPOSE:Perianal fistulous disease is present in 10-15% of children with Crohn's disease (CD) and is frequently complex and refractory to treatment, with one-third of patients having recurrent lesions. We conducted a systematic review of the literature to examine the best surgical strategy or strategies for pediatric complex perianal fistulous disease (CPFD) in CD. METHODS:We searched CENTRAL, MEDLINE, EMBASE, and CINAHL for studies discussing at least one surgical strategy for the treatment of pediatric CPFD in CD. Reference lists of included studies were hand-searched. Two researchers screened all studies for inclusion, quality assessed each relevant study, and extracted data. RESULTS:One non-randomized prospective and two retrospective studies met our inclusion criteria. Combined use of setons and infliximab therapy shows promise as a first-line treatment. A specific form of fistulectomy, "cone-like resection," also shows promise when combined with biologics. Endoscopic ultrasound to guide medical and surgical management is feasible in the pediatric population, though it is unclear if it improves outcomes. CONCLUSION:There is a paucity of evidence regarding the treatment of CPFD in the pediatric population, and further research is required before recommendations can be made as to what, if any, surgical management is optimal.

journal_name

Pediatr Surg Int

authors

Kantor N,Wayne C,Nasr A

doi

10.1007/s00383-017-4067-6

subject

Has Abstract

pub_date

2017-05-01 00:00:00

pages

551-557

issue

5

eissn

0179-0358

issn

1437-9813

pii

10.1007/s00383-017-4067-6

journal_volume

33

pub_type

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