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Perianal Crohn Disease—Invited Critique

Perianal Crohn Disease—Invited Critique Invited Critique norectal problems afflict one fifth of all patients with Crohn disease. Some series report 80% to 90% surgical success 1-4 5-7 A rates in selected patients, but postoperative complications substantially impair some patients. Thus, patient se- lection is critical in deciding whether to be aggressive or to perform conservative procedures such as simple drainage or seton placement. Pikarksy and coauthors propose that a simple score might predict surgical outcome. Prospectively col- lected data and an a priori scoring system yielded a dichotomous distribution that correlated with postoperative outcome when the results were analyzed retrospectively. The study group was small and heterogeneous regarding surgical indica- tions and procedures. Furthermore, half of the patients underwent “conservative procedures” and therefore do not help test the hypothesis that these scores predict whether an aggressive procedure is likely to be successful. (Although potentially corrective, fibrin glue instillation does not carry the same level of postoperative risk as the more aggressive procedures de- scribed.) Concomitant medical therapy for Crohn disease is not discussed but is of particular interest because anti–tumor necrosis factor  antibody facilitates closure of some fistulas. Outcomes were categorized subjectively by surgeons, not by patients or by objective criteria. Nevertheless, http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png JAMA Surgery American Medical Association

Perianal Crohn Disease—Invited Critique

JAMA Surgery , Volume 137 (7) – Jul 1, 2002

Perianal Crohn Disease—Invited Critique

Abstract

Invited Critique norectal problems afflict one fifth of all patients with Crohn disease. Some series report 80% to 90% surgical success 1-4 5-7 A rates in selected patients, but postoperative complications substantially impair some patients. Thus, patient se- lection is critical in deciding whether to be aggressive or to perform conservative procedures such as simple drainage or seton placement. Pikarksy and coauthors propose that a simple score might predict surgical outcome. Prospectively...
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Publisher
American Medical Association
Copyright
Copyright 2002 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.
ISSN
2168-6254
eISSN
2168-6262
DOI
10.1001/archsurg.137.7.778
Publisher site
See Article on Publisher Site

Abstract

Invited Critique norectal problems afflict one fifth of all patients with Crohn disease. Some series report 80% to 90% surgical success 1-4 5-7 A rates in selected patients, but postoperative complications substantially impair some patients. Thus, patient se- lection is critical in deciding whether to be aggressive or to perform conservative procedures such as simple drainage or seton placement. Pikarksy and coauthors propose that a simple score might predict surgical outcome. Prospectively col- lected data and an a priori scoring system yielded a dichotomous distribution that correlated with postoperative outcome when the results were analyzed retrospectively. The study group was small and heterogeneous regarding surgical indica- tions and procedures. Furthermore, half of the patients underwent “conservative procedures” and therefore do not help test the hypothesis that these scores predict whether an aggressive procedure is likely to be successful. (Although potentially corrective, fibrin glue instillation does not carry the same level of postoperative risk as the more aggressive procedures de- scribed.) Concomitant medical therapy for Crohn disease is not discussed but is of particular interest because anti–tumor necrosis factor  antibody facilitates closure of some fistulas. Outcomes were categorized subjectively by surgeons, not by patients or by objective criteria. Nevertheless,

Journal

JAMA SurgeryAmerican Medical Association

Published: Jul 1, 2002

References