- Author
-
E.M. Meima-van Praag
- Title
- Surgical innovations in the multidisciplinary treatment of Crohn’s disease
- Supervisors
- Co-supervisors
-
C.J. Buskens
K.B. Gecse - Award date
- 20 January 2023
- Number of pages
- 253
- ISBN
- 9789464219760
- Document type
- PhD thesis
- Faculty
- Faculty of Medicine (AMC-UvA)
- Abstract
-
This thesis focuses on the surgical treatment of patients with Crohn’s disease.
Part I describes and evaluates multiple treatment methods of perianal fistulas in patients with Crohn’s disease, especially the ligation of the intersphincteric fistula tract procedure and the advancement flap procedure. Multiple clinical outcome parameters as well as radiological healing after these surgical closure procedures were evaluated. Furthermore, outcome parameters after short-term anti-TNF therapy combined with surgical closure were directly compared to medical therapy only as treatment of Crohn’s perianal fistulas in the PISA-II trial; a patient preference randomised controlled trial. Both 18 month and long-term outcomes are described. Also, fistula characteristics on MRI after surgical closure and the relationship between those characteristics to patients’ clinical outcomes were evaluated, and it was evaluated whether certain MRI features could be used to predict clinical outcome in patients after surgical closure.
Part II of this thesis focuses on multiple (new) surgical treatment strategies for different problems of Crohn’s disease. Important dilemmas for medically refractory or complex Crohn’s disease are discussed. Furthermore, a novel treatment method using the Semiflex Dome System, a catheter set for vacuum therapy of perianal abscesses and fistulas is described. Lastly, in order to make management of the complex problem of the chronically failing pouch more comprehensible and make results between different centres more comparable, a new classification system for the surgical treatment of the chronically failing ileo-anal pouch is suggested in this thesis. - Persistent Identifier
- https://hdl.handle.net/11245.1/d5424fce-fc26-46f1-9d35-f81a11a98ce9
- Downloads
-
Thesis (complete)
Front matter
Chapter 1: General introduction and thesis outline
Chapter 2: Systematic review and meta-analysis of endorectal advancement flap and ligation of the intersphincteric fistula tract for cryptoglandular and Crohn’s high perianal fistulas
Chapter 3: Ligation of the intersphincteric fistula tract and endorectal advancement flap for high perianal fistulas in Crohn’s disease – A retrospective cohort study
Chapter 4: Perianal fistula treatment by ligation of the intersphincteric fistula tract or advancement plasty in patients with Crohn’s disease (PLIAC study) – An international prospective cohort study
Chapter 5: Short-term anti-TNF therapy with surgical closure versus anti-TNF therapy in the treatment of perianal fistulas in Crohn’s disease (PISA-II): A patient preference randomised trial
Chapter 6: Long-term outcomes of Crohn’s perianal fistulas treatment: short-term anti-TNF therapy with surgical closure versus anti-TNF therapy (PISA-II) - A patient preference RCT
Chapter 7: Magnetic resonance imaging after ligation of the intersphincteric fistula tract for high perianal fistulas in Crohn’s disease: A retrospective cohort study
Chapter 8: Fibrosis and MAGNIFI-CD activity index at magnetic resonance imaging to predict treatment outcome in perianal fistulizing Crohn’s disease patients
Chapter 9: Surgical management of Crohn’s disease: A state of the art review
Chapter 10: Semiflex assisted vacuum therapy for perianal abscesses and fistula: A study protocol for a pilot study
Chapter 11: Classification of surgical causes of and approaches to the chronically failing ileoanal pouch
Chapter 12: Summary and future perspectives
Nederlandse samenvatting / Dutch summary; List of publications; List of contributing authors; PhD portfolio; Dankwoord / Acknowledgements; About the author
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