PURPOSEcolon;The operative management of patients with fistulahyphen;inhyphen;ano in the presence of Crohn's disease has been controversial. Our aim was to review the results of operative treatment in this clinical setting.METHODScolon;Twentyhyphen;eight such patients treated between 1976 and 1990 were reviewed. The duration of local symptoms, location of the Crohn's disease, medications, and previous operations were noted. An effort was made to classify the fistulahyphen;inhyphen;ano according to Parks' classification, but many fistulas were complicated and did not neatly fit into one of the described categories lpar;intersphincteric 9, transsphincteric 10, complex 9rpar;. Patients underwent fistulotomy lpar;three with a setonrpar;.RESULTScolon;Complete healing was achieved in 71.4 percent of cases with an average healing time of 3.5 months lpar;range, 3 weekshyphen;26 monthsrpar;. With an average followhyphen;up of 71 months lpar;range, 12 monthshyphen;14 yearsrpar;, postoperative function was good in 20 lpar;71.5 percentrpar; patients. Of the remaining eight patients, five ultimately underwent total proctocolectomy because of the severity of their colorectal disease, one patient developed alteration of continence, and two patients developed stenosis. There were two recurrences, lpar;one at nine months and one at six yearsrpar;.CONCLUSIONcolon;Operative treatment should be offered to selected patients with fistulahyphen;inhyphen;ano in the presence of Crohn's disease.
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