Role of Vacuum-Assisted Closure in the Management of Crohn Anal Fistulas.

BACKGROUND

Patients with Crohn disease-related anal fistulas are treated with debridement of fistulous tracts and the placement of noncutting setons (NCSs). However, to reduce the high recurrence rate, there is still a need to develop more effective treatment methods.

OBJECTIVE

To compare NCS with vacuum-assisted closure (VAC) treatment.

METHODS

Medical records of 47 patients with Crohn anal fistulas were retrospectively evaluated. They were divided into two groups (I, VAC; II, NCS), consisting of 24 and 23 patients, respectively. The fistulas in the former group were applied with VAC, whereas NCSs were placed in the latter group. Fistula healing was evaluated with the Fistula Drainage Assessment classification, Perianal Disease Activity Index, and the van Assche MRI-Based Score.

RESULTS

There was a significant difference (P = .006) between the groups; closure of all fistulas at 6 months after treatment was achieved in 18 patients (75%) from group 1, compared with 8 patients (35%) from group 2. Partial response occurred in five patients (21%) from group 1 and in five patients (22%) from group 2. Closure of fistulous tracts was visualized via MRI in nine patients (37.50%) from group 1, more than twice as many patients as from group 2.

CONCLUSIONS

Because preliminary results of the study showed a high rate of closure after application of VAC to Crohn anal fistulas, this method might be considered a novel sphincter-saving procedure.