The Essential Role of a Multidisciplinary Approach in Inflammatory Bowel Diseases: Combined Medical-Surgical Treatment in Complex Perianal Fistulas in CD

Clin Colon Rectal Surg. 2022 Jan 17;35(1):21-31. doi: 10.1055/s-0041-1740035.eCollection 2022 Jan.

Jeroen Geldof 1 2, Nusrat Iqbal 3, Janindra Warusavitarne 3, Ailsa Hart 1 3


Author information

1IBD Unit, St. Mark's Hospital, Harrow, United Kingdom.

2Gastroenterology Department, University Hospital Ghent, Ghent, Belgium.

3Robin Phillips Fistula Research Unit, St. Mark's Hospital, Harrow, United Kingdom.


Perianal fistulizing Crohn's disease (PFCD) represents a challenging and complex disease phenotype. Patients typically suffer a more severe disease course than those without perianal complications and are often managing debilitating symptoms. Etiology is understood to be multifactorial, with genetic predisposition, microbiological insult, aberrant immunity, and mechanical factors all implicated. As a result, multimodal treatment strategies must be employed to achieve disease control and fistula closure. This requires the complimentary involvement of medical and surgical disciplines in order to ensure thorough assessment and treatment tailored to the individual scenario and patient goals. The aim of this article is to describe an overview of the various treatment strategies available for PFCD, focusing on how a synergistic approach is required to ensure maximal chances of success.

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