Sanitising the Perineum

Abscesses must be drained and necrotic tissues excised. Any granulation tissue should be curetted, and sinuses must be deroofed. Simple fistulae should be laid open, more complex fistulae should be drained and the primary track marked by a loose seton. The intention is to end up with a healthy surgical wound from which to use as a starting point. Medical treatments are discussed in a previous chapter and are always considered as the first choice in perineal Crohn's disease treatment. In cases of failure or recurrence, new procedures such as local injection of antibody tumour necrotising factor (TNF) or glue sealing treatment are the second option in fistulae treatment. Finally, if none of these therapies are suc cessful, then quite complicated surgical procedures can be attempted with a reasonable chance of healing. All these procedures and the results will be discussed; the sequence is summarised in an algorithm for treatment of perineal Crohn's disease.

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