{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T04:28:06Z","timestamp":1791520086122,"version":"4.3.4"},"reference-count":31,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,5,13]],"date-time":"2026-05-13T00:00:00Z","timestamp":1778630400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,7,7]],"date-time":"2026-07-07T00:00:00Z","timestamp":1783382400000},"content-version":"vor","delay-in-days":55,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Tech Coloproctol"],"published-print":{"date-parts":[[2026,12]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Fistulotomy is highly effective (&gt;\u200990%) for cryptoglandular fistula-on-ano, but fistulotomy in perianal Crohn\u2019s disease (pCD) is limited due to increased risk of recurrent fistulae, diarrhea, and fecal incontinence. We hypothesized that superficial fistulotomy resulted in wound healing in most patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Method<\/jats:title>\n                    <jats:p>We conducted a single-center retrospective review of adult patients with pCD who underwent fistulotomy from 1999 to 2022. Baseline characteristics, pCD characteristics, and short- and long-term surgical and functional outcomes were reported. Matched-pair Wilcoxon signed-rank test was used to compare continuous data.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A total of 43 adult patients with pCD underwent fistulotomy and were included: 29 (67.4%) were male, with an age of 34 (28\u201342) years\u00a0and a follow-up time of 4.3\u00a0years. Prior interventions included draining setons (48.8%) and partial fistulotomy (17.4%); 25.6% had no prior surgery. Fistulotomies were subcutaneous (65.1%), low transsphincteric (16.3%), intersphincteric (4.7%), and unspecified (14%). Short-term complications included pain (20.9%), bleeding (4.7%), and seepage\u00a0(2.3% each), and 58.1% of the patients had no complications. Long-term complications included bleeding, keyhole deformity, nonhealing wounds, and anal stricture (2.3% each), and 60.5% did not experience long-term complications. At the last follow-up, 41 (95.3%) patients had complete healing of the fistulotomy site.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Fistulotomy was safe in select patients with fistulizing pCD and superficial fistulas with little or no sphincter involvement. We observed that fistulotomy was associated with wound healing, decreased drainage, and social restrictions in most patients, suggesting that this is a viable and safe option for this at-risk group.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s10151-026-03351-3","type":"journal-article","created":{"date-parts":[[2026,5,13]],"date-time":"2026-05-13T18:58:44Z","timestamp":1778698724000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Fistulotomy for superficial or minimal sphincter-involving fistulae in perianal Crohn\u2019s disease: do they heal?"],"prefix":"10.1007","volume":"30","author":[{"given":"Oscar Hernandez","family":"Dominguez","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Janell","family":"Holloway","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anuradha","family":"Bhama","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benjamin L.","family":"Cohen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leonardo","family":"Duraes","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arielle","family":"Kanters","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Olga","family":"Lavryk","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeremy","family":"Lipman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Liska","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefan D.","family":"Holubar","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,5,13]]},"reference":[{"key":"3351_CR1","doi-asserted-by":"publisher","first-page":"875","DOI":"10.1053\/gast.2002.32362","volume":"122","author":"DA Schwartz","year":"2002","unstructured":"Schwartz DA, Loftus EV, Tremaine WJ et\u00a0al. (2002) The natural history of fistulizing Crohn\u2019s disease in Olmsted County. Minnesota Gastroenterology 122:875\u2013880","journal-title":"Minnesota Gastroenterology"},{"key":"3351_CR2","doi-asserted-by":"publisher","first-page":"1477","DOI":"10.1093\/ibd\/izab287","volume":"28","author":"L Tsai","year":"2022","unstructured":"Tsai L, McCurdy JD, Ma C et\u00a0al. (2022) Epidemiology and natural history of perianal Crohn\u2019s disease: a systematic review and meta-analysis of population-based cohorts. Inflamm Bowel Dis 28:1477\u20131484","journal-title":"Inflamm Bowel Dis"},{"key":"3351_CR3","doi-asserted-by":"publisher","first-page":"576","DOI":"10.1016\/S2468-1253(22)00007-3","volume":"7","author":"J Geldof","year":"2022","unstructured":"Geldof J, Iqbal N, LeBlanc JF et\u00a0al. (2022) Classifying perianal fistulising Crohn\u2019s disease: an expert consensus to guide decision-making in daily practice and clinical trials. Lancet Gastroenterol Hepatol 7:576\u2013584","journal-title":"Lancet Gastroenterol Hepatol"},{"key":"3351_CR4","doi-asserted-by":"publisher","unstructured":"Wong S-Y, Rowan C, Diaz Brockmans E, et\u00a0al. Perianal fistulizing Crohn\u2019s disease-associated anorectal and fistula cancers: systematic review and expert consensus . Epub ahead of print 2024. https:\/\/doi.org\/10.1016\/j.cgh.2024.05.029.","DOI":"10.1016\/j.cgh.2024.05.029"},{"key":"3351_CR5","doi-asserted-by":"publisher","DOI":"10.1016\/j.cpsurg.2020.100808","volume":"57","author":"AL Lightner","year":"2020","unstructured":"Lightner AL, Ashburn JH, Brar MS et\u00a0al. (2020) Fistulizing Crohn\u2019s disease. Curr Probl Surg 57:100808","journal-title":"Curr Probl Surg"},{"key":"3351_CR6","doi-asserted-by":"crossref","unstructured":"Meima-van Praag EM, van Rijn KL, Wasmann KATGM, et\u00a0al. (2022) Short-term anti-TNF therapy with surgical closure versus anti-TNF therapy in the treatment of perianal fistulas in Crohn\u2019s disease (PISA-II): a patient preference randomised trial. Lancet Gastroenterol Hepatol. 7:617\u2013626.","DOI":"10.1016\/S2468-1253(22)00088-7"},{"key":"3351_CR7","doi-asserted-by":"publisher","first-page":"1049","DOI":"10.1093\/ecco-jcc\/jjaa004","volume":"14","author":"KA Wasmann","year":"2020","unstructured":"Wasmann KA, Joline de Groof E, Stellingwerf ME et\u00a0al. (2020) Treatment of perianal fistulas in Crohn\u2019s disease, seton versus anti-TNF versus surgical closure following anti-TNF [PISA]: a randomised controlled trial. J Crohn\u2019s Colitis. 14:1049\u20131056","journal-title":"J Crohn\u2019s Colitis."},{"key":"3351_CR8","doi-asserted-by":"publisher","first-page":"4821","DOI":"10.3748\/wjg.v24.i42.4821","volume":"24","author":"J Panes","year":"2018","unstructured":"Panes J, Reinisch W, Rupniewska E et\u00a0al. (2018) Burden and outcomes for complex perianal fistulas in Crohn\u2019s disease: systematic review. World J Gastroenterol 24:4821\u20134834","journal-title":"World J Gastroenterol"},{"key":"3351_CR9","doi-asserted-by":"publisher","first-page":"1253","DOI":"10.1111\/apt.14599","volume":"47","author":"PF Vollebregt","year":"2018","unstructured":"Vollebregt PF, van Bodegraven AA, Markus-de Kwaadsteniet TML et\u00a0al. (2018) Impacts of perianal disease and faecal incontinence on quality of life and employment in 1092 patients with inflammatory bowel disease. Aliment Pharmacol Ther 47:1253\u20131260","journal-title":"Aliment Pharmacol Ther"},{"key":"3351_CR10","doi-asserted-by":"publisher","first-page":"1381","DOI":"10.1136\/gutjnl-2013-306709","volume":"63","author":"KB Gecse","year":"2014","unstructured":"Gecse KB, Bemelman W, Kamm MA et\u00a0al. (2014) A global consensus on the classification, diagnosis and multidisciplinary treatment of perianal fistulising Crohn\u2019s disease. Gut 63:1381\u20131392","journal-title":"Gut"},{"key":"3351_CR11","doi-asserted-by":"publisher","first-page":"80","DOI":"10.1111\/codi.13106","volume":"18","author":"W Graf","year":"2016","unstructured":"Graf W, Andersson M, \u00c5kerlund JE et\u00a0al. (2016) Long-term outcome after surgery for Crohn\u2019s anal fistula. Colorectal Dis 18:80\u201385","journal-title":"Colorectal Dis"},{"key":"3351_CR12","doi-asserted-by":"publisher","first-page":"529","DOI":"10.1007\/BF02058706","volume":"39","author":"YP Sangwan","year":"1996","unstructured":"Sangwan YP, Schoetz DJ, Murray JJ et\u00a0al. (1996) Perianal Crohn\u2019s disease: results of local surgical treatment. Dis Colon Rectum 39:529\u2013535","journal-title":"Dis Colon Rectum"},{"key":"3351_CR13","doi-asserted-by":"publisher","first-page":"1383","DOI":"10.1016\/j.asjsur.2021.03.013","volume":"44","author":"MY Park","year":"2021","unstructured":"Park MY, Yoon YS, Kim HE et\u00a0al. (2021) Surgical options for perianal fistula in patients with Crohn\u2019s disease: a comparison of seton placement, fistulotomy, and stem cell therapy. Asian J Surg 44:1383\u20131388","journal-title":"Asian J Surg"},{"key":"3351_CR14","doi-asserted-by":"publisher","first-page":"159","DOI":"10.1111\/codi.15241","volume":"23","author":"A Herissay","year":"2021","unstructured":"Herissay A, Siproudhis L, Balc\u2019h E, et\u00a0al. (2021) Combined strategies following surgical drainage for perianal fistulizing Crohn\u2019s disease: failure rates and prognostic factors. Color Dis 23:159\u2013168","journal-title":"Color Dis"},{"key":"3351_CR15","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1002\/bjs.1800630102","volume":"63","author":"AG Parks","year":"1976","unstructured":"Parks AG, Gordon PH, Hardcastle JD (1976) A classification of fistula\u2010in\u2010ano. Br J Surg 63:1\u201312","journal-title":"Br J Surg"},{"key":"3351_CR16","doi-asserted-by":"publisher","first-page":"753","DOI":"10.1097\/MIB.0000000000000378","volume":"21","author":"A Fichera","year":"2015","unstructured":"Fichera A, Zoccali M (2015) Guidelines for the surgical treatment of Crohn\u2019s perianal fistulas. Inflamm Bowel Dis 21:753\u2013758","journal-title":"Inflamm Bowel Dis"},{"key":"3351_CR17","doi-asserted-by":"publisher","unstructured":"Adamina M, Minozzi S, Warusavitarne J, et\u00a0al. ECCO guidelines on therapeutics in Crohn\u2019s disease: surgical treatment. https:\/\/doi.org\/10.1093\/ecco-jcc\/jjae089.","DOI":"10.1093\/ecco-jcc\/jjae089"},{"key":"3351_CR18","doi-asserted-by":"publisher","first-page":"964","DOI":"10.1097\/DCR.0000000000002473","volume":"65","author":"WB Gaertner","year":"2022","unstructured":"Gaertner WB, Burgess PL, Davids JS et\u00a0al. (2022) The American Society of Colon and Rectal Surgeons clinical practice guidelines for the management of anorectal abscess, fistula-in-ano, and rectovaginal fistula. Dis Colon Rectum 65:964\u2013985","journal-title":"Dis Colon Rectum"},{"key":"3351_CR19","doi-asserted-by":"publisher","first-page":"211","DOI":"10.1177\/1457496916665763","volume":"106","author":"I Papaconstantinou","year":"2017","unstructured":"Papaconstantinou I, Kontis E, Koutoulidis V et\u00a0al. (2017) Surgical management of fistula-in-ANO among patients with Crohn\u2019s disease: analysis of outcomes after fistulotomy or seton placement\u2014Single-center experience. Scand J Surg 106:211\u2013215","journal-title":"Scand J Surg"},{"key":"3351_CR20","doi-asserted-by":"publisher","first-page":"367","DOI":"10.1093\/ibd\/izac103","volume":"29","author":"M Shehab","year":"2023","unstructured":"Shehab M, Alrashed F, Heron V et\u00a0al. (2023) Comparative efficacy of biologic therapies for inducing response and remission in fistulizing Crohn\u2019s disease: systematic review and network meta-analysis of randomized controlled trials. Inflamm Bowel Dis 29:367\u2013375","journal-title":"Inflamm Bowel Dis"},{"key":"3351_CR21","doi-asserted-by":"publisher","first-page":"1148","DOI":"10.1016\/j.cgh.2023.01.042","volume":"21","author":"BL Cohen","year":"2023","unstructured":"Cohen BL, Lincango E, Holubar SD (2023) How to manage targeted immune suppressants (biologics and oral small-molecule drugs) perioperatively for inflammatory bowel disease and non-inflammatory bowel disease surgery. Clin Gastroenterol Hepatol 21:1148-1151.e1","journal-title":"Clin Gastroenterol Hepatol"},{"key":"3351_CR22","doi-asserted-by":"publisher","first-page":"75","DOI":"10.1111\/codi.16314","volume":"25","author":"M Laland","year":"2023","unstructured":"Laland M, Fran\u00e7ois M, D\u2019Amico F et\u00a0al. (2023) Identification of the optimal medical and surgical management for patients with perianal fistulising Crohn\u2019s disease. Color Dis 25:75\u201382","journal-title":"Color Dis"},{"key":"3351_CR23","doi-asserted-by":"publisher","first-page":"204","DOI":"10.1053\/j.gastro.2022.03.057","volume":"163","author":"BL Cohen","year":"2022","unstructured":"Cohen BL, Fleshner P, Kane SV et\u00a0al. (2022) Prospective cohort study to investigate the safety of preoperative tumor necrosis factor inhibitor exposure in patients with inflammatory bowel disease undergoing intra-abdominal surgery. Gastroenterology 163:204\u2013221","journal-title":"Gastroenterology"},{"key":"3351_CR24","doi-asserted-by":"publisher","first-page":"98","DOI":"10.14423\/SMJ.0000000000001214","volume":"114","author":"Z Moosvi","year":"2021","unstructured":"Moosvi Z, Duong JT, Bechtold ML et\u00a0al. (2021) Systematic review and meta-analysis: preoperative Vedolizumab and postoperative complications in patients with IBD. South Med J 114:98\u2013105","journal-title":"South Med J"},{"key":"3351_CR25","doi-asserted-by":"publisher","DOI":"10.1097\/mcg.0000000000001943","author":"SP Bachour","year":"2023","unstructured":"Bachour SP, Shah RS, Joseph A et\u00a0al. (2023) Change in biologic class promotes endoscopic remission following endoscopic postoperative Crohn\u2019s disease recurrence. J Clin Gastroenterol. https:\/\/doi.org\/10.1097\/mcg.0000000000001943","journal-title":"J Clin Gastroenterol"},{"key":"3351_CR26","doi-asserted-by":"publisher","first-page":"708","DOI":"10.1093\/ecco-jcc\/jjab168","volume":"16","author":"KL Van Rijn","year":"2022","unstructured":"Van Rijn KL, Meima-Van Praag EM, Bossuyt PM et\u00a0al. (2022) Fibrosis and MAGNIFI-CD activity index at magnetic resonance imaging to predict treatment outcome in perianal fistulizing Crohn\u2019s disease patients. J Crohn\u2019s Colitis 16:708\u2013716","journal-title":"J Crohn\u2019s Colitis"},{"key":"3351_CR27","doi-asserted-by":"publisher","DOI":"10.1007\/s00261-024-04238-3","author":"N Richard","year":"2024","unstructured":"Richard N, Derinck A, Bridoux V et\u00a0al. (2024) Which magnetic resonance imaging feature is associated with treatment response in perianal fistulizing Crohn\u2019s disease? Abdom Radiol. https:\/\/doi.org\/10.1007\/s00261-024-04238-3","journal-title":"Abdom Radiol"},{"key":"3351_CR28","doi-asserted-by":"publisher","first-page":"357","DOI":"10.1093\/ibd\/izad134","volume":"30","author":"E Crowley","year":"2024","unstructured":"Crowley E, Ma C, Guizzetti L et\u00a0al. (2024) Recommendations for standardizing MRI-based evaluation of perianal fistulizing disease activity in pediatric Crohn\u2019s disease clinical trials. Inflamm Bowel Dis 30:357\u2013369","journal-title":"Inflamm Bowel Dis"},{"key":"3351_CR29","doi-asserted-by":"publisher","DOI":"10.1093\/ecco-jcc\/jjad214","author":"SK Vuyyuru","year":"2023","unstructured":"Vuyyuru SK, Solitano V, Singh S et\u00a0al. (2023) Scoring indices for perianal fistulising Crohn\u2019s disease: a systematic review. J Crohns Colitis. https:\/\/doi.org\/10.1093\/ecco-jcc\/jjad214","journal-title":"J Crohns Colitis"},{"key":"3351_CR30","doi-asserted-by":"publisher","first-page":"21","DOI":"10.1055\/s-0041-1740035","volume":"35","author":"J Geldof","year":"2022","unstructured":"Geldof J, Iqbal N, Warusavitarne J et\u00a0al. (2022) The essential role of a multidisciplinary approach in inflammatory bowel diseases: the essential role of a multidisciplinary approach in inflammatory bowel diseases: combined medical-surgical treatment in complex perianal fistulas in CD. Clin Colon Rectal Surg 35:21","journal-title":"Clin Colon Rectal Surg"},{"key":"3351_CR31","doi-asserted-by":"publisher","first-page":"1181","DOI":"10.1136\/gutjnl-2017-314918","volume":"67","author":"PG Kotze","year":"2018","unstructured":"Kotze PG, Shen B, Lightner A et\u00a0al. (2018) Modern management of perianal fistulas in Crohn\u2019s disease: future directions. Gut 67:1181\u20131194","journal-title":"Gut"}],"container-title":["Techniques in Coloproctology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s10151-026-03351-3","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s10151-026-03351-3.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s10151-026-03351-3.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,7]],"date-time":"2026-07-07T03:21:57Z","timestamp":1783394517000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s10151-026-03351-3"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,13]]},"references-count":31,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2026,12]]}},"alternative-id":["3351"],"URL":"https:\/\/doi.org\/10.1007\/s10151-026-03351-3","relation":{"has-preprint":[{"id-type":"doi","id":"10.21203\/rs.3.rs-7376465\/v1","asserted-by":"object"}]},"ISSN":["1123-6337","1128-045X"],"issn-type":[{"value":"1123-6337","type":"print"},{"value":"1128-045X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,13]]},"assertion":[{"value":"14 August 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"16 April 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"13 May 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors declare no competing interests.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"This retrospective chart review study involving human participants was in accordance with the ethical standards of the institutional and national research committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards. The Human Investigation Committee (IRB) of Cleveland Clinic approved this study. The authors are accountable for all aspects of the work and ensure that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. This study was approved by the Institutional Review Board of our institution.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}},{"value":"Informed consent is not required as retrospective chart review was anonymized, and the submission does not include images that may identify the person.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Informed consent"}},{"value":"This study is original, written without the use of generative AI, has not been published elsewhere, and was presented at the American Society of Colon and Rectal Surgeons Annual Scientific Meeting on 1\u20134 June 2024, Baltimore, MD, USA.","order":5,"name":"Ethics","group":{"name":"EthicsHeading","label":"Originality"}},{"value":"During the preparation of this work, the author used PaperPal to proofread the grammar and punctuation. After using this tool\/service, the author(s) reviewed and edited the content as needed and take full responsibility for the publication\u2019s content.","order":6,"name":"Ethics","group":{"name":"EthicsHeading","label":"AI"}}],"article-number":"99"}}