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Tumor necrosis factor (TNF) blockers, with or without antibiotics such as ciprofloxacin and metronidazole, are commonly used to treat severe perianal Crohn disease. Fecal diversion is sometimes used for patients with severe refractory disease.
A meta-analysis of 16 cohort studies including 556 patients found that 64% of patients had initial improvement after fecal diversion for refractory perianal Crohn disease. In 15 studies, takedown of an ostomy was attempted in only 35% of patients. The rate of attempting restoration of continuity was similar before and after 1998 when biologic therapies came into use. The rate of successful restoration of continuity (long-term clinical response without the need for further surgery) was only 14% in the p…