P0497Skin tag excision in Crohn’s Disease and risk of non-healing wounds: a contemporary case series and systematic review with meta-analysis

Abstract Background Traditionally, perianal skin tag excision has been contraindicated in patients with Crohn’s disease (CD) owing to risk of non-healing wounds. We aimed to conduct a systematic review of the literature with meta-analysis, including our institutional data, on outcomes after perianal skin tag excision in patients with CD. We hypothesized that perianal skin tag excision in CD would be associated with non-healing wounds. Methods A literature search was conducted using the MEDLINE, PubMed, Embase and Cochrane Library databases for patients with CD who underwent perianal skin tag excision or limited excisional hemorrhoidectomy. Studies reporting only on patients with ulcerative colitis or on non-operative intervention on perianal disease were excluded. For our institutional series, a retrospective review of adults with CD between 2012 and 2024 who underwent skin tag excision in isolation or with limited excisional hemorrhoidectomy was conducted. A meta-analysis on rate of complete wound healing was conducting across all relevant studies, using a generalized linear mixed model. Results Twelve retrospective studies fitting inclusion criteria were identified in the literature (Table 1). All identified studies were either retrospective cohort studies (N = 7) or case series (N = 5). Nine studies reported on operative intervention and postoperative outcomes, including rate of complete wound healing. The remaining three studies reported either on natural history of perianal CD focusing on risk factors (N = 2), or histologic analysis of excisional perianal specimens in CD (N = 1). At our institution, forty-five (100%) patients with CD underwent excision of skin tags; either in isolation (62%) or with limited excisional hemorrhoidectomy (44%). Long-term complications were observed in nine (20%) patients overall; long-term complication rate was higher in patients with prior perianal surgery for CD (40% vs 10%, p = 0.04). Complete wound healing was observed in 41 patients (91.1%) in our institutional series. Meta-analysis on complete wound healing (10 studies, pooled N = 249), showed a pooled likelihood of wound healing of 97% (95% confidence interval 84-100%, prediction interval 27-100%). A forest plot was generated (Figure 1), which demonstrated moderate heterogeneity across studies (I2 = 30%). Conclusion Perianal skin tag excision in carefully selected patients with CD resulted in wound healing in most patients, and can be considered for lifestyle-limiting symptoms. In our data, history of prior surgery for perianal Crohn’s disease was associated with a higher rate of long-term complications. Conflict of interest: Dr. Unal, Ece: No conflict of interest Kc, Devesh: No conflict of interest Silva, Nicholas: No conflict of interest Nero, Neil: No conflict of interest Tang, Li: No conflict of interest Lavryk, Olga: No conflict of interest Kanters, Arielle: No conflict of interest Spivak, Anna: No conflict of interest Lipman, Jeremy: No conflict of interest Fulmer, Clifton: No conflict of interest Falloon, Katherine: No conflict of interest Qazi, Taha: No conflict of interest Cohen, Benjamin: Abbvie - consulting and speaking ALPCO - consulting J & J Innovative Medicine - consulting Takeda - consulting and speaking Emmes Biopharma Services LLC - DSMB Pfizer - consulting Holubar, Stefan: Grant: Surgical Research Network Grant American Society of Colon & Rectal Surgeons Grant Personal Fees: Shionogi, Takeda, Guidepoint