Surgery for symptomatic hemorrhoids and anal fissures in Crohn's disease
Tóm tắt
This study was undertaken to determine the outcome of surgery for symptomatic hemorrhoids and anal fissures in patients with known Crohn's disease. Seventeen patients underwent surgery for symptomatic hemorrhoids. Fifteen of these 17 patients' wounds healed without complication. Twenty-five patients underwent 27 operations for anal fissures. Twenty-two of these patients had uncomplicated wound healing by two months. Long-term follow-up, which was at a mean of 11.5 years in the hemorrhoid patients and 7.5 years in the fissure patients, revealed that only three patients required proctectomy, none as a direct result of surgery. Patients with severe symptoms secondary to anal fissures and hemorrhoids, who are known to have Crohn's disease and who cannot be controlled with conservative medical management, may undergo surgery on a highly selective basis when the disease is in the quiescent state. Proctectomy is not an inevitable outcome.
Tài liệu tham khảo
Jeffrey PJ, Ritchie JK, Parks AG. Treatment of hemorrhoids in patients with inflammatory bowel disease. Lancet 1977;1:1084–5.
Levien DH, Surrell JA, Mazier WP. Surgical treatment of anorectal fistula in patients with Crohn's disease. Surg Gynecol Obstet 1989;169:133–6.
Morrison JG, Gathright JB Jr, Ray JE, Ferrari BT, Hicks TC, Timmcke AE. Surgical management of anorectal fistulas in Crohn's disease. Dis Colon Rectum 1989;32:492–6.
Williams DR, Coller JA, Corman ML, Nugent FW, Veidenheimer MC. Anal Complications in Crohn's disease. Dis Colon Rectum 1981;24:22–4.
Atwell JD, Duthie JL, Goligher JC. The outcome of Crohn's disease. Br J Surg 1965;52:966–72.
Fielding JF. Perianal lesions in Crohn's disease. J R Coll Surg Edinb 1972;17:32–7.
Schofield PF. The natural history and treatment of Crohn's disease. Ann R Coll Surg Engl 1965;36:258–79.
Lockhart-Mummery HE. Pathologic lesions of the anal region associated with Crohn's disease. Dis Colon Rectum 1965;8:399–401.
Baker WN, Milton-Thompson GJ. Management of anal fistulas in Crohn's disease. J R Soc Med 1974;67:8.
Bernard D, Morgan S, Tasse D. Selective surgical management of Crohn's disease of the anus. Can J Surg 1986;29:318–21.
Wolff BG, Culp CE, Beart RW Jr, Ilstrup DM, Ready DL. Anorectal Crohn's disease: a long-term perspective. Dis Colon Rectum 1985;28:709–11.
Alexander-Williams J, Buchmann P. Perianal Crohn's disease. World J Surg 1980;4:203–8.
Buchmann P, Keighley MR, Allan RN, Thompson H, Alexander-Williams J. Natural history of perianal Crohn's disease. Ten years follow-up: a plea for conservatism. Am J Surg 1980;140:642–4.
Cohen Z. Crohn's disease: perianal. In: Fazio VW, ed. Current therapy in CNR surgery. Toronto: B.C. Decker, 1990:199–202.