P390 Medical and surgical treatment of haemorrhoids and anal fissure in Crohn's disease

Abstract

Background: Currently, despite advances in medical and surgical treatments, the principle of avoid surgery for haemorrhoids and/or anal fissure in Crohn’s disease patients is still valid. In this study we report our prospectively recorded data on medical and surgical treatment of haemorrhoids and anal fissures in CD patients over a period of 8 years. Methods: Clinical data of patients affected by perianal disease were routinely and prospectively inserted in a database between October 2002 and June 2010 at the Department of Surgery, Tor Vergata University Hospital, Rome. We reviewed records on CD patients treated either medically or surgically and divided in two groups according to the diagnosis of haemorrhoids or anal fissures. Moreover, in each group, outcomes between patients in whom CD was discovered before or after perianal main treatment were compared. Results: Eighty-six CD patients were included in the study; 45 were treated for haemorrhoids and 41 presented with anal fissure. Conservative approach was initially adopted in all the patients; in case of failure of medical treatment, they were evaluated for surgery in presence of stable intestinal disease. Fifteen patients underwent haemorrhoidectomy (open 11; closed 3; stapled 1), and two rubber band ligation. Surgery for anal fissure was required in 14 patients (Botox 8; LIS 6). In both groups we observed high complication rate, 47.1% and 57.1% for haemorrhoids and anal fissure respectively. Patients submitted to haemorrhoidectomy without certain diagnosis of CD had significantly higher risk of complication Conclusions: Conservative treatment of proctological disease in CD patients has been advocated given the high risk of complications and the evidence that spontaneous healing may also occur. Considering our results, surgery for haemorrhoids and anal fissure should be avoided and when necessary reserved to patients with quiescent disease. In selected patients, it is associated to good outcome and acceptable postoperative complications. Options like rubber band ligations and Botulinum toxin injection are helpful.