ABSTRACT
This chapter reviews classification and scoring systems relevant for the treatment of perianal fistulas, to overview the optimal use of imaging modalities and to identify established principles and remaining challenges in the multidisciplinary management of perianal disease. Perianal Crohn’s disease is associated with significant impairment in quality of life and is a predictor of inflammatory bowel disease-related work disability. Fistula Drainage Assessment was first used in the randomised controlled trial (RCT), which evaluated the efficacy of infliximab in Crohn’s fistulas and led to regulatory approval. Two RCTs were assessed and have proven the efficacy of induction and maintenance treatment of infliximab in fistulising Crohn’s disease (CD). Seton drainage is generally considered to be the first step for any form of treatment of complex fistulas, medically or surgically. The rationale for using cell therapy to treat CD perianal fistulas is based on the pathophysiological mechanisms of wound healing.
