Current Management of
Fistulating Perianal Crohn’s

A collaborative survey

Twenty-six percent of Crohn’s patients develop an anal fistula over a 20-year period with approximately a third suffer from one in their lifetime and the pathophysiology behind their development is not fully understood. The individual healthcare associated costs of management of fistulating perianal Crohn’s Disease is up to 10,000 Euros per year for those receiving biological therapy, with approximately 25% of this cost attributed to surgery and hospitalisation.

The management of this disease revolves around accurate diagnosis, removal of sepsis and control of the disease process, often requiring a combination of surgical and medical intervention, which may or may not include biological therapy. The most ideal imaging would involve a combination of multiple modalities, most commonly endoanal ultrasound and pelvic MRI, and examination under anaesthesia. The goal of therapy for these patients has shifted from complete fistula closure to reducing drainage from the fistula to improve their quality of life, however there is no current consensus for optimum management.

The treatment of fistulating perianal disease has been identified as a key topic for colorectal surgeons in the recent ACPGBI Delphi exercise. The proposed questionnaire regarding current management of perianal Crohn’s disease has been informed by a pilot, which was distributed to 20 consultants earlier this year.


To provide a survey of current national practice and help determine the intervention arm for a prospective randomised trial inform a national.

What’s Involved

Distribute the paper questionnaire amongst consultant surgeons at your site(s). Then collect the responses and input into an online database. The overall target is 200 responses. In order to obtain collaborative authorship (PubMed citable), we are asking each person to obtain a minimum of 4 responses and input them into the system by mid-November.


This questionnaire will report on UK surgical practice in fistulating perianal Crohn’s disease. We plan to submit to a quality colorectal or surgical journal such as Colorectal Disease, DCR or the BJS. This data may also be presented at a surgical meeting, with authorship presented as above.