Superficial Fistulotomy for Non-Transsphincteric Fistulae in Perianal Crohn’s Disease: Do They Heal?

Abstract BackgroundFistulotomy is highly effective (> 90%) for cryptoglandular fistula-on-ano, but fistulotomy in perianal Crohn’s disease (pCD) is limited due to increased risk of recurrent fistulae, diarrhea, and fecal incontinence. We hypothesized superficial fistulotomy resulted in wound healing in most patients.MethodWe conducted a single-center retrospective review of adult patients with pCD who underwent fistulotomy from 1999–2022. Baseline characteristics, pCD characteristics, and short- and long-term surgical and functional outcomes were reported. Matched-pair Wilcoxon signed-rank test was used to compare continuous data.ResultsA total of 43 adult pCD patients underwent fistulotomy and were included: 29 (67.4%) males, age of 34 (28–42) years, and a follow-up time of 4.3 years. Prior interventions included draining setons (48.8%) and partial fistulotomy (17.4%); 25.6% had no prior surgery. Fistulotomies were subcutaneous (65.1%), low transsphincteric (16.3%), intersphincteric (4.7%), and unspecified (14%). Short-term complications included pain (20.9%), bleeding (4.7%), and seepage (2.3% each), and 58.1% of the patients had no complications. Long-term complications included bleeding, keyhole deformity, non-healing wounds, and anal stricture (2.3% each), and 60.5% did not experience long-term complications. At the last follow-up, 41 (95.3%) patients had complete healing of the fistulotomy site.ConclusionFistulotomy was safe in select patients with fistulizing pCD and superficial fistulas with little or no sphincter involvement. We observed that fistulotomy was associated with wound healing, decreased drainage, and social restrictions in most patients, suggesting that this is a viable and safe option for this at-risk group.