Crohnʼs Perianal Fistulas and the Incidence of Fecal Incontinence: 794

Purpose: Crohn's disease (CD) perianal fistulas can cause significant morbidity including fecal incontinence. The rate of fecal incontinence in these patients (pts) varies in the literature. The purpose of this study was to assess the rate of fecal incontinence in pts with CD perianal fistulas and to determine if there is a difference in outcomes between those pts who have undergone primarily medical or surgical treatment for their perianal disease Methods: The medical records of pts who presented to the GI Clinic at a single academic medical center between 1/01 and 1/04 with perianal CD were reviewed. Demographic data and information regarding treatment was recorded. Mailed questionnaires and telephone interviews were conducted to determine the Fecal Incontinence Severity Index (FISI) score and patient satisfaction. Results: Of 77 pts identified with CD perianal fistulas, a total of 40 (52%) completed the questionnaire. 25 (63%) pts had surgical treatment while15 had medical treatment only. The baseline demographic data was similar in both groups. The overall rate of fecal incontinence was high with 64% of all pts having ≥ 1 episode a week of solid stool incontinence. There was no difference between the medical and surgical cohorts (67% vs. 60%; p = .75) The median FISI for the medical group was 37, (range 0 – 59) while the median FISI for the surgical cohort was 33 (range 4–56; p = .54). The type of surgical treatment did not affect outcome. Surgical pts who had less invasive operations (incision and drainage or seton placement) had a median FISI of 31, and pts who underwent more aggressive surgical treatment (fistulotomy, fistulectomy, or advancement flap) had a median FISI 42 (p = .52). Surgical pts were asked to rate their degree of satisfaction (1 = poor and 5 = excellent). Pearson's product moment analysis revealed there was not a strong relationship between level of satisfaction and FISI score (correlation = .06, p = .78) Conclusions: The rate of fecal incontinence in pts with perianal CD is high. There is not a significant difference in the degree of fecal incontinence between pts treated medically or surgically for perianal CD, nor is there a significant difference in fecal incontinence with the different surgical procedures. Surgical pts with higher FISI scores are not necessarily less satisfied with their surgical results