Laser ablation of complex perianal fistulas preserves continence and is a rectum-sparing alternative in Crohn's disease patients.

摘要: A 20-year review of the inflammatory bowel disease surgical database author was analyzed for Crohn's (CD) patients who had a approach to perianal fistula (PAD). Of 333 with CD operated between July 1977 and February 1997, 51 procedures PAD (15.3%), 7 these laser ablation severe, debilitating complex (13.7%). These have traditionally been treated by diverting ileostomy or proctectomy permanent diversion. Others advocated conservative management long-term antibiotics, staged operations, insertion multiple loose setons promote drainage. This technique adapted from procedure now severe hydradenitis suppurativa. The hand-held CO2 used unroof all fistulas external sphincter. Fistulas were identified probing. Infected granulation tissue removed until normal fat muscle revealed. Intersphincteric abscesses unroofed, single seton placed around sphincter but submucous fistulas. Patients usually as outpatients pain control effected oral transnasal agents. laparoscopically performed temporary in one early patient series. followed, progress documented physical examination photographs. Quality life assessed. All improved remarkably their preoperative state. 4 group more than 1 year before this demonstrated complete healing. three recent are various stages Continence preserved patients. No has required rectal excision. Recurrence thought be related associated occurred patient. Laser is valuable complicating CD. It effectively eradicates septic tracks pockets while preserving function. obviates need diversion without proctectomy.