The role of surgery for children with perianal Crohn’s disease

PurposeChildren with perianal Crohn’s disease (PCD) are a unique and diverse patient population. The purpose of this study was to describe the spectrum of disease and role of surgery.MethodsA retrospective chart review of all children having at least one surgical intervention for PCD over 10 years was performed.ResultsFifty-seven patients (63% male) aged 0.5–17 (median 13) years were identified. Perianal disease consisted of skin tags (49%), superficial fistulae (49%), deep fistulae (37%), superficial abscesses (68%), deep abscesses (9%), skin breakdown (19%), and anal strictures (7%). 84% received anti-TNF therapy, with 27% treated with a second anti-TNF medication. Minor surgical procedures, commonly done during anti-TNF therapy, included abscess drainage (67%) and seton placement (33%). Major surgical procedures, done almost exclusively after anti-TNF failure, included defunctioning ileostomy (23%) and subtotal colectomy (9%). Follow-up ranged from 7 to 160 (median 54) months.ConclusionsPediatric PCD has a wide range of disease severity. Minor surgery provides adequate drainage before and during anti-TNF therapy, while major surgery plays a role in medically refractory disease. Appropriate surgical intervention remains an important part of the treatment paradigm.