Complex Perianal Fistulas and Crohn's Disease - Management ...
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Description

Complex Perianal Fistulas and Crohn's Disease - Management Algorithm
Factors for Operative Strategy
  • Fistula Classification and Location
  • Sphincter Involvement
  • Active Abscess
  • Failure of Medical Tx/Prior Op Tx
  • History of Incontinence
  • Active Proctitis
Horseshoe Abscess*
  • Commonly refractory to standard drainage techniques & diversion
  • Modified Hanley Procedure: sphincter- preserving multifaceted drainage
     o Consider large penrose drain
     o Prolonged post-op care
TDM & IFX **
  • IFX TL target > 15mcg/ml if no response to standard dosing for PAF
VDZ/UST & PAF **
  • ENTERPRISE: 43% pts. with PAF closure @ week 30 in DB-RCT of two VDZ arms
  • GETAID BIOLAP: MCT cohort studies: UST success (38.5%) > VDZ success (22.5%)
Patient Experience
  • 66% patients report that pain or chronic/relapsing symptoms most impacted physical/emotional health/QOL
  • 25% report inadequate emotional support
  • Pt. report that emotional, social, body image, relational impact of perianal disease often overlooked by clinicians
  • Pt. report feeling stigmatized, ashamed b/o their perianal disease

Algorithm by Dr. Waseem Ahmed @Waseem_AhmedMD

#Perianal #Fistulas #Crohns #Disease #IBD #algorithm #management 
Contributed by

Dr. Gerald Diaz
@GeraldMD
Board Certified Internal Medicine Hospitalist, GrepMed Editor in Chief 🇵🇭 🇺🇸 - Sign up for an account to like, bookmark and upload images to contribute to our community platform. Follow us on IG:  https://www.instagram.com/grepmed/ | Twitter: https://twitter.com/grepmeded/
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