On Friday 27 September, delegates packed into Plenary Hall A for the final symposium at ESCP’s 14th Annual Meeting in Vienna, Austria. The session, ‘Simple solutions for challenging perineal problems’, included presentations from four renowned colorectal specialists and was chaired by Ethem Gecim (Turkey) and Iain Anderson (UK).

Long-standing ESCP Education committee member, David Zimmerman (Netherlands) kicked off the symposium with a discussion regarding the optimal approach to a high fistula-in-ano. He began by exclaiming that there are simply no simple solutions, rather complex ones that must be adopted with the utmost care and responsibility.

David explained the rationalisation behind implementing a seton and whether it should come before or after LIFT, as well as commonly accepted techniques and their risks and dangers. He argued perianal fistula is a very common problem that is often treated by junior doctors, with little experience and knowledge about it.

Speaking about patient care, he urged the importance of being open and honest with patients, as well as considering doing nothing or fitting a comfortable seton if an operation is not entirely necessary.

Next up was an energetic presentation from Phil Tozer (UK) who discussed the multidisciplinary management of complex fistula-in-ano.

He discussed the current options regarding the management of complex fistulae in Crohn’s patients, drawing on relevant research papers, and called for better coordination between gastroenterologists, surgeons, dietitians/CNS and the patient to fuel necessary collaboration and improve patient outcomes.

Yves Panis (France) took the stage next to deliver his presentation on the prevention and management of non-healing perineal wounds following Crohn’s proctectomy. He outlined the indications of total coloproctectomy in patients with Crohn’s Disease which included refractory perineal disease, refractory proctitis after ileorectal anastomosis and the failure of previous ileal pouch-anal anastomosis.

Yves also explained the possible courses of treatment required, however called for further research and studies to be undertaken across Europe.

Lastly, Stephanie Breukink (The Netherlands) discussed chronic pain, anal stenosis, and recurrent symptoms post-haemorrhoidectomy using patient case studies.

She described her frustration at being unable to find literature to support relevant studies related to chronic pain and haemorrhoidectomies whilst patients continually share devastating stories with her in hope of a quick solution.

She argued there is indeed no simple solution for this and rather emphasised the importance of prevention and further research being undertaken. She called on experienced surgeons to be aware of the possibility of stenosis occurring post anorectal surgery (the narrowing of the anal canal) and advised to not resect too much at once, leaving sufficient anoderm intact.

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