Perianal disease is frequently linked to a more severe phenotype of Crohn's disease (CD) compared to luminal disease and may develop either before, after, or independently of luminal symptoms [1]. A total of 17 %–50 % of patients with CD develop perianal fistulas and about one third of these patients suffer from recurrent fistula formation [2]. The retrospective Crohn's Disease Clinical Network and Cohort [CONNECT] study from Korea found a significant association between perianal fistulas and younger age, male gender, and rectal involvement [3,4]. The use of corticosteroids [5], abdominal penetrating behavior [6], and extraintestinal manifestations [6,7], were also associated with higher risk of perianal disease. In adult patients with CD and active perianal fistulas without perianal abscesses, guidelines recommend the use of biological therapy, offering the potential to improve symptoms, reduce the need for surgery, and enhance quality of life [8,9]. Infliximab was the first medication that had a dedicated randomized controlled trial to assess the efficacy of the drug to induce fistula remission [10]. However approximately two-thirds of patients with perianal CD require perianal surgery, particularly in the presence of abscesses [11]. The primary goals of treatment for perianal fistulas in CD are to achieve fistula healing and prevent or treat infections and sepsis. A multidisciplinary approach involving a surgeon, gastroenterologist, and radiologist is often necessary to address the complexities of this condition [12].