Our Summary

This research paper discusses the treatment of perianal disease in patients with Crohn’s Disease (CD). The main form of treatment is medical, but surgery should be considered for severe or repeated instances of the disease. Ideally, medical and surgical treatments should be used together by a team of different medical professionals. There have been significant advances in treating fistulas (abnormal connections between organs) associated with Crohn’s, especially with less invasive procedures. Recent clinical trials have shown success with the use of mesenchymal stem cells. For some patients with severe, resistant disease, they may need to have a procedure to divert their feces or remove their rectum. When considering reversing these procedures, the most important factor is stopping inflammation of the rectum.

FAQs

  1. When should surgical management be considered for perianal CD?
  2. What are the recent developments in the treatment of Crohn’s-related fistulas?
  3. What factors are considered important when thinking about reversing a diverting or end ileostomy?

Doctor’s Tip

One helpful tip a doctor might tell a patient about proctectomy is to discuss the potential risks and benefits of the surgery thoroughly with their healthcare team. It is important for the patient to understand the potential complications, recovery process, and long-term outcomes associated with proctectomy before making a decision. Additionally, the patient should follow their healthcare team’s post-operative care instructions carefully to promote healing and reduce the risk of complications.

Suitable For

Patients with severe or refractory Crohn’s disease, particularly those with perianal involvement such as fistulas or abscesses, are typically recommended for proctectomy. These patients may have failed multiple medical treatments and have significant symptoms that impact their quality of life. Additionally, patients with severe proctitis or those who require fecal diversion may also be candidates for proctectomy. It is important for these patients to be evaluated by a multidisciplinary team to determine the best course of treatment, which may include a combination of medical and surgical interventions.

Timeline

Before proctectomy:

  1. Patient may experience symptoms of perianal disease such as pain, swelling, discharge, and difficulty with bowel movements.
  2. Patient may undergo various medical treatments such as medications, antibiotics, and biologic therapies to manage symptoms and control inflammation.
  3. Surgical options such as fistulotomy, seton placement, or abscess drainage may be considered to address complications of perianal disease.
  4. In cases of severe or refractory disease, proctectomy may be recommended as a last resort to remove the affected portion of the colon and rectum.

After proctectomy:

  1. Patient undergoes surgery to remove the affected portion of the colon and rectum.
  2. Recovery period may involve pain management, wound care, and dietary adjustments to promote healing.
  3. Patient may require a temporary or permanent ostomy (ileostomy or colostomy) to divert stool from the remaining portion of the bowel.
  4. Follow-up care may include monitoring for complications, adjusting medications, and managing any remaining symptoms of Crohn’s disease.
  5. In some cases, reversal of the ostomy may be considered once inflammation is under control and the patient is deemed a suitable candidate for surgery.

What to Ask Your Doctor

  1. What are the potential risks and complications associated with a proctectomy?

  2. How long is the recovery period after a proctectomy?

  3. Will I need to make any lifestyle changes or adjustments after the surgery?

  4. What type of follow-up care will be necessary after the proctectomy?

  5. Will I need to undergo any additional treatments or therapies after the proctectomy?

  6. How likely is it that I will need a permanent colostomy or ileostomy after the proctectomy?

  7. Are there any alternative treatment options to consider before moving forward with a proctectomy?

  8. How successful is a proctectomy in treating severe or recurrent perianal Crohn’s disease?

  9. What is the long-term prognosis for patients who undergo a proctectomy for Crohn’s disease?

  10. How experienced are you in performing proctectomies for Crohn’s disease, and what is your success rate?

Reference

Authors: Truong A, Zaghiyan K, Fleshner P. Journal: Surg Clin North Am. 2019 Dec;99(6):1151-1162. doi: 10.1016/j.suc.2019.08.012. Epub 2019 Sep 21. PMID: 31676054