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AIM: to assess the functional outcomes following management of perianal fistulizing Crohn’s disease. PATIENTS AND METHODS : a retrospective study was done from April 2018 to September 2024, comparing continence function before and after surgery (median follow-up 4.2 months) in 150 patients with perianal Crohn’s disease (pCD). Sphincter function was assessed before and after surgery using the Wexner scale and anorectal manometry. Uni- and multivariate binary logistic regression analyses were performed to identify risk factors for clinical anal incontinence (AI). RESULTS: the incidence of clinical anal incontinence (AI), defined as a Wexner score of ≥ 2, was assessed in nonstoma patients and was 90/132 (68%) preoperatively and 84/119 (71%) postoperatively. No significant differences in frequency were observed (p = 0.84). However, a significant increase in Wexner scale scores was noted in the late postoperative period (preoperative median: 3 points [Q1; Q3: 1; 7]; postoperative median: 5 points [Q1; Q3: 1; 9]; p = 0.007). Univariate analysis identified factors associated with an increased risk of clinical AI after surgery: longer duration of perianal CD symptoms (OR = 1.17; 95% CI: 1.01–1.38; p = 0.04), a history of surgery for anal fistulas (OR = 0.33; 95% CI: 0.15–0.75; p = 0.008), a higher number of previous operations (OR = 2.16; 95% CI: 1.01–4.6; p = 0.046), including a greater number of previous incision and drainage procedures for perianal abscesses (OR = 1.85; 95% CI: 1.12–3.08; p = 0.017), and a higher number of rectal fistulas (OR = 2.25; 95% CI: 1.04–4.87; p = 0.039). However, multivariate analysis failed to confirm the statistical significance of these factors. The manometric incidence of AI was 120/150 (80%) preoperatively and 137/150 (91%) postoperatively (p = 0.0004). Patients with normal preoperative manometry had a higher incidence of postoperative AI (p = 0.02). The Average Anal Resting Pressure was below the reference range in 116 (77%) cases preoperatively and in 137 (91%) cases postoperatively, indicating a significant decrease after surgery (p = 0.001). No factors predisposing to an increased risk of manometric AI were identified. CONCLUSION: the results obtained showed an increase in the rate of postoperative anal incontinence in patients with perianal Crohn’s disease. It is necessary to apply an individual approach to surgery, taking into account the patient’s medical history and current condition.