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P210. Are combined medical and surgical treatments optimal therapy for complex perianal fistula in Crohn's disease?

J. Kim, S. Kang, K. Park, H. Jung, I. Song

Seoul National University College of Medicine, Seoul, Republic of Korea

Background/Aims: The optimal treatment for complex perianal fistula in Crohn's disease has not been known. We conducted this study to assess therapeutic response and recurrence rate of complex perianal fistula in Crohn's disease with regard to treatment options.

Methods: A total of 85 Crohn's disease patients with complex perianal fistula were prospectively enrolled in single center and then analyzed retrospectively. Patients underwent medical (antibiotics and/or immunomodulators), surgical (fistulotomy and/or seton drainage) or combined medical and surgical treatment for fistula. Initial response to treatment was evaluated at 3 months on the basis of cessation of active drainage. Recurrence was defined as re-development of fistula among patients with initial response. Predictive factors affecting response to therapy and the recurrence of fistula were analyzed by multivariate analysis.

Results: Medical treatment was performed in 22 (25.9%) patients, surgical treatment in 13 (15.3%), and combined surgical and medical treatment in 50 (58.8%). Initial response rate of the combined treatment group was 68.0% (34/50), which was significantly higher than the medical (40.9%, 9/22) or surgical treatment group (38.5%, 5/13) (P = 0.03). As determined by multivariate analysis, treatment option was the only significant factor influencing the initial response rate. The recurrence rate of fistula was 45.7% (22/48) at 5 years. Patients receiving medical maintenance showed a significantly lower recurrence rate than patients who didn't receive maintenance therapy (36.7% vs. 100.0% at 5 yrs, p = 0.01).

Conclusions: Combined surgical and medical treatment results in better healing rate of complex perianal fistula and medical maintenance therapy lowers recurrence rate.