Local surgery vs resection for anal fistula in CD

What is known

• Local operation before curative resection failed to heal in 38% (8/22) of small-intestinal and 43% (9/21) of combined ileocolic cases, i.e. ~60% healed. ¹
• After primary curative resection, spontaneous fistula healing occurred in 47%, but reopened within ~2.5 years in about 35% of those. ¹
• Small-intestinal and ileocolic disease had a good long-term prognosis (~90% healed at follow-up), though many required repeated local operations. ¹
• In colonic disease local surgery was not followed by healing (83% did not heal), and rectal Crohn's with anal fistula invariably led to proctocolectomy. ¹

What is unknown / caveats

• Single retrospective cohort from 1955–1974, predating modern imaging, seton/biologic-era management
• No randomized or direct head-to-head comparison of local surgery vs resection; healing definitions and follow-up vary
• Healing in the resection arm often required repeated local operations, so the arms are not cleanly separable
• The evidence rests almost entirely on one historical cohort and does not directly compare the two strategies in a modern (seton, anti-TNF) treatment context.

References

1. Hellers G, Bergstrand O, Ewerth S, Holmström B. Occurrence and outcome after primary treatment of anal fistulae in Crohn's disease. Gut. 1980;21(6):525-7. PMID: 7429313.

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