DOI: https://doi.org/10.22263/2312-4156.2026.2.22
V.L. Denisenko1,2, E.V. Denisenko1, I.S. Anosov3, Yu.M. Gain4, S.V. Shakhrai4, M.Yu. Gain4, Zh.I. Teryushkova5, S.V. Malashenko6, A.I. Moskalev3
Perianal Crohn’s disease: current state of the issue and prospects for improving treatment results
1Vitebsk Regional Specialized Clinical Center, Vitebsk. Republic of Belarus
2Vitebsk State Order of Peoples’ Friendship Medical University, Vitebsk, Republic of Belarus
3National Research Center of Proctology named after A.N.Ryzhikh of the Ministry of Health of the Russian Federation, Moscow, Russian Federation
4Belarusian State Medical University, Minsk, Republic of Belarus
5City Clinical Hospital № 8 of Chelyabinsk, Chelyabinsk, Russian Federation
6Vitebsk Regional Clinical Pathology Bureau, Vitebsk, Republic of Belarus
Vestnik VGMU. 2026;25(2):22-32.
Abstract.
Introduction. Anal fistulas are a common complication, occurring in 25% of patients with Crohn’s disease. Approximately half of these complications are severe. Treatment options for patients with conditions refractory to medical therapy are limited worldwide, and recurrent surgeries are associated with a significant risk of developing a permanent intestinal stoma. Initial clinical results have demonstrated the efficacy of stromal-vascular fraction in the treatment of this condition.
Objectives. To analyze the current literature on perianal Crohn’s disease and identify promising approaches for its comprehensive treatment.
Material and Methods. Using PubMed, Cochrane Library, and eLibrari.ru, we identified and analyzed 657 scientific sources covering current aspects of the diagnosis and treatment of perianal Crohn’s disease. Promising areas for its comprehensive treatment are identified, with the strengths and weaknesses of each method being assessed.
Results. The article analyzes available domestic and international literature on new approaches to the comprehensive treatment of anal fistulas associated with Crohn’s disease.
Conclusions. Prospects for the treatment of perianal Crohn’s disease may be driven by two factors. One is the development and clinical application of new effective drugs and biological agents for the treatment of Crohn’s disease. Another promising direction may be the expansion of indications for the use of local treatments. In this area, the use of autologous stromal-vascular fraction of the adipose tissue appears to be the most likely source of positive results.
Keywords: perianal Crohn’s disease, anal fistulas, inflammatory bowel disease, drug therapy, surgical treatment, stromal-vascular fraction of the adipose tissue.
References
1. Parfenov AI. Crohn's disease: on the occasion of the 80th anniversary of description. Terapevticheskiĭ Arkhiv. 2013;85(8):35-42.
2. Yamamoto-Furusho JK, Sarmiento-Aguilar A, Toledo-Mauriño JJ, Bozada-Gutiérrez KE, Bosques-Padilla FJ, Martínez-Vázquez MA, et al. Incidence and prevalence of inflammatory bowel disease in Mexico from a nationwide cohort study in a period of 15 years (2000–2017). Medicine (Baltimore). 2019 Jul;98(27):e16291. doi: http://dx.doi.org/10.1097/MD.0000000000016291
3. Coward S, Clement F, Benchimol EI, Bernstein CN, Avina-Zubieta JA, Bitton A, et al. Past and future burden of inflammatory bowel diseases based on modeling of population-based data. Gastroenterology. 2019 Apr;156(5):1345-1353. doi: http://dx.doi.org/10.1053/j.gastro.2019.01.002
4. Raven L. Chronic inflammatory condition (CIC) nurses in regional Australia : a proposal for 2022-23 budget submissions. URL: https://treasury.gov.au/sites/default/files/2022-03/258735_crohns_and_colitis_australia.pdf [Accessed 27th March 2026].
5. Busingye D, Pollack A, Chidwick K. Prevalence of inflammatory bowel disease in the Australian general practice population: a cross-sectional study. PLoS One. 2021 May;16(5):e0252458. doi: http://dx.doi.org/10.1371/journal.pone.0252458
6. Nielsen K, Yarker J, Randall R, Munir F. The mediating effects of team and self-efficacy on the relationship between transformational leadership and job satisfaction and psychological well-being in healthcare professionals: a cross-sectional questionnaire survey. International Journal of Nursing Studies. 2009 Sep;46(9):1236-1244. doi: http://dx.doi.org/10.1016/j.ijnurstu.2009.03.001
7. Van Assche G, Dignass A, Panes J, Beaugerie L, Karagiannis J, Allez M, et al. The second European evidence-based consensus on the diagnosis and management of Crohn’s disease: definitions and diagnosis. Journal of Crohn's & Colitis. 2010 Feb;4(1):7-27. doi: http://dx.doi.org/10.1016/j.crohns.2009.12.003
8. Shelygin YA, Ivashkin VT, Achkasov SI, Reshetov IV, Maev IV, Belousova EA, et al. Clinical guidelines. Crohn’s disease (K50), adults. Koloproktologiya. 2023;22(3):10-49. doi: http://dx.doi.org/10.33878/2073-7556-2023-22-3-10-49
9. Chaparro M, Zanotti C, Burgueño P, Vera I, Bermejo F, Marín-Jiménez I, et al. Health care costs of complex perianal fistula in Crohn’s disease. Digestive Diseases and Sciences. 2013 Dec;58(12):3400-3406. doi: http://dx.doi.org/10.1007/s10620-013-2830-7
10. Van Assche G, Dignass A, Reinisch W, Van der Woude CJ, Sturm A, De Vos M, et al. The second European evidence-based consensus on the diagnosis and management of Crohn’s disease: special situations. Journal of Crohn's & Colitis. 2010 Feb;4(1):63-101. doi: http://dx.doi.org/10.1016/j.crohns.2009.09.009
11. Sandborn WJ, Fazio VW, Feagan BG, Hanauer SB. AGA technical review on perianal Crohn’s disease. Gastroenterology. 2003 Nov;125(5):1508-1530. doi: http://dx.doi.org/10.1016/j.gastro.2003.08.025
12. Bell SJ, Williams AB, Wiesel P, Wilkinson K, Cohen RCG, Kamm MA. The clinical course of fistulating Crohn’s disease. Alimentary Pharmacology and Therapeutics. 2003 May;17(9):1145-1151. doi: http://dx.doi.org/10.1046/j.1365-2036.2003.01561.x
13. Molendijk I, Nuij VJ, van der Meulen-de Jong AE, Van der Woude CJ. Disappointing durable remission rates in complex Crohn’s disease fistula. Inflammatory Bowel Diseases. 2014 Nov;20(11):2022-2028. doi: http://dx.doi.org/10.1097/MIB.0000000000000148
14. Saro C, De la Coba C, Casado MA, Resource use in patients with Crohn’s disease treated with infliximab. Alimentary Pharmacology and Therapeutics. 2007 Nov;26(10):1313-1323. doi: http://dx.doi.org/10.1111/j.1365-2036.2007.03507.x
15. Zwintscher NP, Shah PM, Agarwal A, Chesley PM, Johnson EK, Newton CR, et al. The impact of perianal disease in young patients with inflammatory bowel disease. International Journal of Colorectal Disease. 2015 Sep;30(9):1275-1279. doi: http://dx.doi.org/10.1007/s00384-015-2251-5
16. Riss S, Schwameis K, Mittlböck M, Sexual function and quality of life after surgical treatment for anal fistulas in Crohn’s disease. Techniques in Coloproctology. 2013 Feb;17(1):89-94. doi: http://dx.doi.org/10.1007/s10151-012-0890-x
17. Parks AG, Gordon PH, Hardcastle JD. A classification of fistula-in-ano. The British Journal of Surgery. 1976 Jan;63(1):1-12. doi: http://dx.doi.org/10.1002/bjs.1800630102
18. Panes J, Bouhnik Y, Reinisch W, Imaging techniques for assessment of inflammatory bowel disease: joint ECCO and ESGAR evidence-based consensus guidelines. Journal of Crohn's & Colitis. 2013 Aug;7(7):556-585. doi: http://dx.doi.org/10.1016/j.crohns.2013.02.020
19. Navarro-Luna A, García-Domingo MI, Rius-Macías J, Marco-Molina C. Ultrasound study of anal fistulas with hydrogen peroxide enhancement. Diseases of the Colon and Rectum. 2004 Jan;47(1):108-114. doi: http://dx.doi.org/10.1007/s10350-003-0015-8
20. Geese KB, Bemelman W, Kamm MA, A global consensus on the classification, diagnosis and multidisciplinary treatment of perianal fistulising Crohn’s disease. Gut. 2014 Sep;63(9):1381-1392. doi: http://dx.doi.org/10.1136/gutjnl-2013-306709
21. Makowiec F, Jehle EC, Becker HD, Starlinger M. Perianal abscess in Crohn’s disease. Diseases of the Colon and Rectum. 1997 Apr;40(4):443-50. doi: http://dx.doi.org/10.1007/BF02258390
22. De Groof EJ, Sahami S, Lucas C, Treatment of perianal fistula in Crohn’s disease: systematic review and meta-analysis. Colorectal Disease. 2016 Jul;18(7):667-675. doi: http://dx.doi.org/10.1111/codi.13311
23. Marzo M, Felice C, Pugliese D, Andrisani G, Mocci G, Armuzzi A, et al. Management of perianal fistulas in Crohn’s disease: an up-to-date review. World Journal of Gastroenterology. 2015 Feb;21(5):1394-403. doi: http://dx.doi.org/10.3748/wjg.v21.i5.1394
24. Hong MK, Craig Lynch A, Bell S, Woods RJ, Keck JO, Johnston MJ, et al. Faecal diversion in the management of perianal Crohn’s disease. Colorectal Disease. 2011 Feb;13(2):171-176. doi: http://dx.doi.org/10.1111/j.1463-1318.2009.02092.x
25. Pellino G, Selvaggi F. Surgical treatment of perianal fistulizing Crohn’s disease. The Scientific World Journal. 2014:2014:146281. doi: http://dx.doi.org/10.1155/2014/146281
26. Wang JY, Hart SL, Wilkowski KS, Delmotte EC, Del Rosario KM, et al. Gender-specific differences after proctectomy for IBD. Diseases of the Colon and Rectum. 2011 Jan;54(1):66-76. doi: http://dx.doi.org/10.1007/DCR.0b013e3181fd48d2
27. E. J. de Groof, V. N. Cabral, Buskens CJ, Morton DG, Hahnloser D, Bemelman WA, et al. Systematic review and consensus on perianal fistula. Colorectal Disease. 2016 Apr;18(4):O119-O134. doi: http://dx.doi.org/10.1111/codi.13286
28. Dejaco C, Harrer M, Waldhoer T, Miehsler W, Vogelsang H, Reinisch W. Antibiotics and azathioprine for perianal fistulas in Crohn’s disease. Alimentary Pharmacology and Therapeutics. 2003 Dec;18(11-12):1113-1120. doi: http://dx.doi.org/10.1046/j.1365-2036.2003.01793.x
29. West RL, Van der Woude CJ, Hansen BE, Felt-Bersma RJF, Van Tilburg AJP, Drapers JAG, et al. Ciprofloxacin with infliximab for perianal fistulae. Alimentary Pharmacology and Therapeutics. 2004 Dec;20(11-12):1329-1336. doi: http://dx.doi.org/10.1111/j.1365-2036.2004.02247.x
30. Present DH, Rutgeerts P, Targan S, Hanauer SB, Mayer L, Van Hogezand RA, et al. Infliximab for the treatment of fistulas in patients with Crohn’s disease. The New England Journal of Medicine. 1999 May;340(18):1398-1405. doi: http://dx.doi.org/10.1056/NEJM199905063401804
31. Sandborn WJ, Feagan BG, Rutgeerts P, Hanauer S, Colombel JF, Sands BE, et al. Vedolizumab as induction and maintenance therapy for Crohn’s disease. The New England Journal of Medicine. 2013 Aug;369(8):711-721. doi: http://dx.doi.org/10.1056/NEJMoa1215739
32. Wils P, Bouhnik Y, Michetti P, Flourie B, Brixi H, Bourrier A, et al. Subcutaneous ustekinumab provides clinical benefit for two-thirds of patients with crohn's disease refractory to anti-tumor necrosis factor agents. Clinical Gastroenterology and Hepatology. 2016 Feb;14(2):242-250.e1-2. doi: http://dx.doi.org/10.1016/j.cgh.2015.09.018
33. Al-Waili NS, Butler GJ. Effects of hyperbaric oxygen on inflammatory response to wound and trauma: possible mechanism of action. The Scientific World Journal. 2006 Apr:6:425-441. doi: http://dx.doi.org/10.1100/tsw.2006.78
34. Garcia-Olmo D, Schwartz DA. Cumulative Evidence That Mesenchymal Stem Cells Promote Healing of Perianal Fistulas of Patients With Crohn’s Disease-Going From Bench to Bedside. Gastroenterology. 2015 Oct;149(4):853-857. doi: http://dx.doi.org/10.1053/j.gastro.2015.08.038
35. Ciccocioppo R, Gallia A, Sgarella A, Kruzliak P, Gobbi PG, Corazza GR. Long-term аollow-up of crohn disease fistulas after local injections of bone marrow-derived mesenchymal stem cells. Mayo Clinic Proceedings. 2015 Jun;90(6):747-755. doi: http://dx.doi.org/10.1016/j.mayocp.2015.03.023
36. Nasseri Y, Cassella L, Berns M, Zaghiyan K, Cohen J, et al. The anal fistula plug in Crohn's disease patients with fistula-in-ano: a systematic review. Colorectal disease. 2016;18:351-356. doi: http://dx.doi.org/10.1111/codi.13268
37. Senéjoux A, Siproudhis L, Abramowitz L, Munoz-Bongrand N, Desseaux K, Bouguen G, et al. Fistula plug in Fistulising Ano-Perineal Crohn's Disease: a Randomised Controlled Trial. Journal of Crohn's & Colitis. 2016 Feb;10(2):141-148. doi: http://dx.doi.org/10.1093/ecco-jcc/jjv162
38. Giamundo P, Esercizio L, Geraci M, Tibaldi L, Valente M. Fistula-tract Laser Closure (FiLaC™): long-term results and new operative strategies. Techniques in Coloproctology. 2015 Aug;19(8):449-453. doi: http://dx.doi.org/10.1007/s10151-015-1282-9
39. Aguilera-Castro L, Ferre-Aracil C, Garcia-Garcia-de-Paredes A, Rodriguez-de-Santiago E, Lopez-Sanroman A. Management of complex perianal Crohn's disease. Annals of Gastroenterology. 2017;30(1):33-44. doi: http://dx.doi.org/10.20524/aog.2016.0099
Submitted 31.01.2026
Accepted 14.04.2026
Information about authors:
Valery L. Denisenko – chief physician of Vitebsk Regional Clinical Specialized Center; Doctor of Medical Sciences, professor of the Chair of General Surgery, Vitebsk State Order of Peoples’ Friendship Medical University, https://orcid.org/0000-0003-2394-340X, e-mail: Этот адрес электронной почты защищён от спам-ботов. У вас должен быть включен JavaScript для просмотра.;
E.V. Denisenko – surgeon of the surgical department, Vitebsk Regional Clinical Specialized Center;
I.S. Anosov – Candidate of Medical Sciences, associate professor, coloproctologist, National Research Center of Proctology named after A.N. Ryzhikh, Moscow, Russian Federation;
Yu.M. Gain – Doctor of Medical Sciences, professor of the Chair of Military-field Surgery, Belarusian State Medical University, https://orcid.org/0000-0001-7622-5642
S.V. Shakhrai – Doctor of Medical Sciences, professor of the Chair of Surgery and Endoscopy, Belarusian State Medical University;
M.Yu. Gain – Candidate of Medical Sciences, associate professor of the Chair of Surgery and Endoscopy, Belarusian State Medical University;
Zh.I. Teryushkova – Doctor of Medical Sciences, professor, head of the coloproctology department, City Clinical Hospital № 8 of Chelyabinsk, chief coloproctologist of Chelyabinsk region;
S.V. Malashenko – Candidate of Medical Sciences, associate professor, head of Vitebsk Regional Clinical Pathology Bureau;
A.I. Moskalev – Candidate of Medical Sciences, associate professor, head of the scientific and educational department, National Medical Research Center of Coloproctology named after A.N. Ryzhikh, Moscow, Russian Federation.
