Medical and surgical treatment of haemorrhoids and anal fissure in Crohn’s disease: a critical appraisal

BMC Gastroenterology

Pierpaolo Sileri²  Achille L Gaspari²  Nicola Di Lorenzo²  Giovanni Milito²  Emma Calabrese³  Giovanna Del Vecchio Blanco³  Laura Leccesi¹  Federica Cadeddu²  Luana Franceschilli²  Stefano D'Ugo² 

[1] Department of Internal Medicine, Catholic University, Rome, Italy;Department of Surgery, University Hospital Tor Vergata, Viale Oxford 81, Rome 00133, Italy;Department of Gastroenterology, University Hospital Tor Vergata, Rome, Italy

关键词: Surgery;    Botox;    Crohn’s disease;    Anal fissure;    Haemorrhoids;   

Others  :  858131
DOI  :  10.1186/1471-230X-13-47

 received in 2012-05-05, accepted in 2013-02-28,  发布年份 2013

【 摘 要 】

Background

The principle to avoid surgery for haemorrhoids and/or anal fissure in Crohn’s disease (CD) patients is still currently valid despite advances in medical and surgical treatments. In this study we report our prospectively recorded data on medical and surgical treatment of haemorrhoids and anal fissures in CD patients over a period of 8 years.

Methods

Clinical data of patients affected by perianal disease were routinely and prospectively inserted in a database between October 2003 and October 2011 at the Department of Surgery, Tor Vergata University Hospital, Rome. We reviewed and divided in two groups records on CD patients treated either medically or surgically according to the diagnosis of haemorrhoids or anal fissures. Moreover, we compared in each group the outcome in patients with prior diagnosis of CD and in patients diagnosed with CD only after perianal main treatment.

Results

Eighty-six CD patients were included in the study; 45 were treated for haemorrhoids and 41 presented with anal fissure. Conservative approach was initially adopted for all patients; in case of medical treatment failure, the presence of stable intestinal disease made them eligible for surgery. Fifteen patients underwent haemorrhoidectomy (open 11; closed 3; stapled 1), and two rubber band ligation. Fourteen patients required surgery for anal fissure (Botox ± fissurectomy 8; LIS 6). In both groups we observed high complication rate, 41.2% for haemorrhoids and 57.1% for anal fissure. Patients who underwent haemorrhoidectomy without certain diagnosis of CD had significantly higher risk of complications.

Conclusions

Conservative treatment of proctologic diseases in CD patients has been advocated given the high risk of complications and the evidence that spontaneous healing may also occur. From these preliminary results a role of surgery is conceivable in high selected patients, but definitve conclusions can’t be made. Further randomized trials are needed to establish the efficacy of the surgical approach, giving therapeutic recommendations and guidelines.

【 授权许可】

   
2013 D'Ugo et al.; licensee BioMed Central Ltd.

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