Mr. Phil Tozer

How Can We Best Manage Crohn’s Perianal Fistulas (CPF)?

The number of procedures to treat any problem is often an indication of the efficacy and success of those procedures. The continually increasing already relatively large number of procedures designed to treat anal fistulas is a clear attestation to the lack of any one panacea therapy. In this second episode of our four-part series on anal fistulas in patients with Crohn’s disease, we review a variety of medical and surgical options. Our renowned expert faculty describe the indications, techniques, and results of many surgical and non-surgical modalities ranging from traditional established interventions such as setons to emerging methods. A robust panel discussion with active interaction with our global audience will ensure a thorough discussion of all of these topics.

With Takeda

Approaches to Rectovaginal and Extrasphincteric Fistula

Surgery is the mainstay of treatment of anal fistulas. The surgical treatment of complex anal fistulas, particularly those involving a significant portion of the anal sphincter, or high fistulas, in which fistulotomy would compromise continence, is challenging. Patient choice focuses on a compromise between the risk of recurrence and the risk of impairment of continence. Extrasphincteric fistulas can originate in a segment of sigmoid diverticular disease, or from terminal ileal–sigmoid Crohn’s disease, when abdominal resection of the affected part can be quite easy. However, if the fistula arises from the rectum itself, and especially when associated sepsis is marked, surgical management can be extremely challenging. On the other hand we can also talk about rectovaginal fistula. It may arise after obstetric injury, perianal sepsis, in Crohn’s disease, and after radiation, malignancy or trauma including iatrogenic injury. A low anastomosis after an anterior resection or restorative proctocolectomy may fistulate to the vagina. Surgery for a rectovaginal fistula is difficult and success rates are modest, particularly in Crohn’s disease. Recurrence, a permanent stoma, dyspareunia, anal stenosis, and incontinence may all ensue. In this lecture, Phil Tozer explains the different types of complex fistulas in colorectal pathology and the most appropriate treatments in each case to obtain the best results and benefits for each patient. [Image]