P422. Outpatient anal exploration and fistula treatment in Crohn's disease patients with peri-anal disease. Study of feasibility
R. Scaramuzzo1, E. Iaculli2, C. Fiorani3, L. Biancone1, T. Giorgia3, D.C. Sara3, A. Gaspari3, G. Sica3, 1Tor Vergata, Italy, 2Guy's and St Thomas' Hospital, Surgery, London, United Kingdom, 3Tor Vergata Roma, Italy
One third of Crohn's disease (CD) patients presents fistula in ano. Peri-anal disease (PAD) in CD patients can be clinically asymptomatic or extremely severe. Gold standard in the diagnosis and treatment of symptomatic PAD in CD is the exploration of the anal canal and distal rectum under anesthesia (EUA). This procedure is generally offered as a day case surgery. Giving the shortage of resources, it is not always possible to proceed as planned, and an incorrect timing may well represent a relevant issue in the clinical management of these patients.
In a prospective longitudinal study we aimed to assess the feasibility of an outpatient assessment and treatment of symptomatic PAD in CD patients.
All CD patients under regular follow-up at our Inflammatory Bowel Disease referral center, presenting with symptomatic PAD, were offered surgical consultation. Data of patients seen between February 2010 until April 2011 were collected for the purpose of the study. All clinical information, including previous EUA and/or records from Magnetic Resonance Imaging and endoscopic ultrasound were reviewed. Outpatient anal canal exploration (OE) and treatment was undertaken during the specialist surgical consultation. Fistula were classified according to Park's classification; type of outpatient treatment and compliance were recorded and pain was assessed by VAS scale at the time of the procedure. Patients were followed up in the surgical clinic for 12 months.
During the study period, 26 CD patients with symptomatic PAD were referred to the surgical outpatient clinic. All the 26 non selected patients were offered surgical exploration. Compliance was excellent as none refused the proposed treatment. It was possible to perform a full OE in 23 (88%) patients. In tab 1 are reported details of procedure and findings. In 23 patients (88%) it was possible to complete OE of the anal canal and distal rectum. Out of these 23 patients in 20 (87%) a surgical procedure was undertaken (77% of the grand total).
From this preliminary experience, OE and fistula treatment because of symptomatic PAD in CD seems to be feasible in referral centers, with results comparable with most EUA series.