Carbon dioxide laser ablation of perianal fistulas in patients with Crohn's disease: experience with 27 patients

Background: Perianal fistula disease (PAD) occurs in up to 40% of patients with Crohn's disease (CD). Medical therapy is often unsuccessful, and, with surgical therapy, healing is unreliable and management is frequently painful and unsatisfactory. Outpatient CO2 laser ablation of PAD has emerged as an alternative. Methods: Twenty-seven patients were evaluated by chart review. The severity of PAD based on a 5 category scoring system was collected. Scores were recorded at the time of surgery and at each subsequent postoperative visit. Results: Differences between PAF severity scores were significant for the initial operation versus postoperative visit 1 (P < .001) and for the initial operation versus the final visit (P < .001). Variation in the postoperative PAD score was affected by the score in the operating room and colonic involvement of CD. Conclusion: CO, laser ablation therapy successfully treats PAD; many fistulas are completely healed and others are converted into a single, minimally draining fistula with this well-tolerated outpatient procedure. (c) 2006 Excerpta Medica Inc. All rights reserved.