Cirugia espanola · 2025
Multidisciplinary management of perianal fistula in Crohn's disease: Protocol implementation and its clinical and quality of life outcomes.
СтатьяНазвание и аннотация: Перевод в очереди
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González Alcolea Natalia, Martín Arranz M Dolores, Monje Vera Blanca, Álvarez Gallego Mario, Díez Sebastián Jesús, Pascual Miguelañez Isabel
Аннотация
INTRODUCTION: Perianal fistula is a common and disabling complication of Crohn's disease, with a significant impact on patients' quality of life. Although structured protocols exist in some centres, no universally accepted management guideline is currently available. In this context, we developed and implemented a protocol in our centre aimed at reducing suppuration, preserving continence, and improving quality of life.
METHODS: A single-centre prospective study was conducted, including 38 patients treated at La Paz University Hospital between January 2020 and January 2022. The protocol combined surgical drainage, seton placement, and biological therapy for at least one year. Indications for curative surgery were based on clinical and radiological criteria. Clinical outcomes, continence (Wexner score), perianal disease activity (Perianal Disease Activity Index [PDAI]), and quality of life (Inflammatory Bowel Disease Questionnaire-9 [IBDQ-9], and a specific 20-item questionnaire) were assessed.
RESULTS: Curative surgery was performed in 55.2% of patients, with a clinical recurrence rate of 31.6%, and no worsening of continence. The IBDQ-9 score was significantly improved (from 59 to 65.4; P < .001). The disease-specific questionnaire revealed a significant impact on social, occupational, emotional, and sexual aspects, particularly among women. Fear of chronic seton use and incontinence was common, and symptomatic control more closely associated with better quality of life than complete fistula healing.
CONCLUSIONS: Implementation of the protocol led to improved quality of life. We emphasise the importance of incorporating disease-specific patient-reported outcome measures (PROMs) and adopting a comprehensive perspective, including the patient's experience as a core component of the therapeutic process.
METHODS: A single-centre prospective study was conducted, including 38 patients treated at La Paz University Hospital between January 2020 and January 2022. The protocol combined surgical drainage, seton placement, and biological therapy for at least one year. Indications for curative surgery were based on clinical and radiological criteria. Clinical outcomes, continence (Wexner score), perianal disease activity (Perianal Disease Activity Index [PDAI]), and quality of life (Inflammatory Bowel Disease Questionnaire-9 [IBDQ-9], and a specific 20-item questionnaire) were assessed.
RESULTS: Curative surgery was performed in 55.2% of patients, with a clinical recurrence rate of 31.6%, and no worsening of continence. The IBDQ-9 score was significantly improved (from 59 to 65.4; P < .001). The disease-specific questionnaire revealed a significant impact on social, occupational, emotional, and sexual aspects, particularly among women. Fear of chronic seton use and incontinence was common, and symptomatic control more closely associated with better quality of life than complete fistula healing.
CONCLUSIONS: Implementation of the protocol led to improved quality of life. We emphasise the importance of incorporating disease-specific patient-reported outcome measures (PROMs) and adopting a comprehensive perspective, including the patient's experience as a core component of the therapeutic process.