Abstract
Complex perianal Crohn's disease (CD) remains a challenging problem. Fecal stream
is thought to be a trigger of disease progression in patients with CD. In patients
with refractory perianal CD, diversion of fecal stream is sometimes required to alleviate
clinical symptoms when medical and local surgical management are unsuccessful. Several
studies evaluated the outcomes of fecal diversion for complex perianal CD. After fecal
diversion, the majority of patients achieved early clinical response, but the prospect
of restoring bowel continuity was low (approximately 20%). Nearly half of the patients
eventually required proctectomy. A number of studies attempted to identify predictive
factors for the outcomes of fecal diversion. Only rectal involvement was associated
with unsuccessful restoration of bowel continuity. Biologic therapy did not seem to
improve the efficacy of fecal diversion, although the evidence level was low because
of insufficient data or methodological limitations. Based on these results, fecal
diversion may be useful in alleviating clinical symptoms related to severe perianal
CD and avoiding immediate proctectomy. The impact of biologic therapy on the outcomes
of fecal diversion should be further investigated.
Keywords
Crohn's disease - perianal Crohn's disease - fecal diversion - proctectomy - biologic
therapy
