{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,30]],"date-time":"2026-10-30T14:51:25Z","timestamp":1793371885420,"version":"4.5.0"},"reference-count":53,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2014,8,13]],"date-time":"2014-08-13T00:00:00Z","timestamp":1407888000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Aliment Pharmacol Ther"],"published-print":{"date-parts":[[2014,10]]},"abstract":"<jats:title>Summary<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>The management of perianal Crohn's fistulas represents a significant challenge. A combination of medical and surgical therapy, guided by radiology, is often required.<\/jats:p><\/jats:sec><jats:sec><jats:title>Aim<\/jats:title><jats:p>To review systematically the literature to assess fistula healing rates with medical treatment (anti\u2010<jats:styled-content style=\"fixed-case\">TNF<\/jats:styled-content>\u2010\u03b1 therapies \u00b1 immunomodulators) or surgical treatment alone, compared with combined medical and surgical treatment in fistulising perianal Crohn's disease (<jats:styled-content style=\"fixed-case\">CD<\/jats:styled-content>).<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>The Preferred Reporting Items for Systematic Reviews and Meta\u2010Analyses (<jats:styled-content style=\"fixed-case\">PRISMA<\/jats:styled-content>) guidelines were used. Two independent reviewers searched the literature.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Twenty\u2010four articles were included. The total population was 1139 patients; 460 (40%) received single treatment with either medical or surgical therapy, and 679 (60%) received combined medical and surgical therapy. Eight studies compared single and combination therapy, with a total population of 797 patients (single therapy: <jats:italic>n<\/jats:italic>\u00a0=\u00a0448, combination therapy: <jats:italic>n<\/jats:italic>\u00a0=\u00a0349). In the single therapy group, 191\/448 were in complete remission (43%). This was lower than the healing rate of the combination therapy group 180\/349 (52%). No response to therapy was noted in 34% (153\/448) of the single therapy group compared with 23% (80\/349) of the combination group.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Combined surgical and medical (anti\u2010<jats:styled-content style=\"fixed-case\">TNF<\/jats:styled-content>\u2010\u03b1 \u00b1 immunomodulators) therapy may have additional beneficial effects on perianal fistula healing in patients with Crohn's disease, compared with surgery or medical therapy alone. A well\u2010designed Crohn's perianal fistula clinical trial is required in a multidisciplinary medical and surgical setting, with clearly defined end points of clinical (and likely patient reported outcomes) and radiological healing.<\/jats:p><\/jats:sec>","DOI":"10.1111\/apt.12906","type":"journal-article","created":{"date-parts":[[2014,8,13]],"date-time":"2014-08-13T14:15:11Z","timestamp":1407939311000},"page":"741-749","source":"Crossref","is-referenced-by-count":131,"title":["Systematic review: the combined surgical and medical treatment of fistulising perianal Crohn's disease"],"prefix":"10.1111","volume":"40","author":[{"given":"N. 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