Outcomes of Definitive Draining Seton Placement for Complex Anal Fistula in Crohn’s Disease

Mujukian, Angela; Zaghiyan, Karen; Banayan, Elliot; Fleshner, Phillip

doi:10.1177/0003134820964462

Cited by 4 publications

(2 citation statements)

References 14 publications

(20 reference statements)

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“…Of these, 166 were included in the full text review. Seventy‐six were further excluded, leaving 90 studies for data extraction [17–106] (Figure 1). Of the 90 studies, there were 53 retrospective studies, 16 prospective observational studies, 16 RCTs, four case series and one cross‐sectional study.…”

Section: Resultsmentioning

confidence: 99%

The use of core descriptors from the ENiGMA code study in recent literature: a systematic review

Khan,

Arline,

Williams

et al. 2024

Colorectal Disease

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AimThe heterogeneity in data quality presented in studies regarding Crohn's anal fistula (CAF) limit extrapolation into clinical practice. The ENiGMA collaborators established a core descriptor set to standardize reporting of CAF. The aim of this work was to quantify the use of these descriptors in recent literature.MethodWe completed a systematic review of PubMed and the Cochrane Library, extracting publications from the past 10 years specific to the clinical interventions and outcomes of CAF, and reported in line with PRISMA guidance. Each article was assessed for inclusion of ENiGMA descriptors. The median number of descriptors per publication was evaluated along with the overall frequency of each individual descriptor. Use of ENiGMA descriptors was compared between medical and procedural publications.ResultsNinety publications were included. The median number of descriptors was 15 of 37; 16 descriptors were used in over half of the publications while 17 were used in fewer than a third. Descriptors were more frequently used in procedural (n = 16) than medical publications (n = 14) (p = 0.031). In procedural publications, eight descriptors were more frequently used including Faecal incontinence, Number of previous fistula interventions, Presence and severity of anorectal stenosis and Current proctitis. Medical publications were more likely to include Previous response to biological therapy and Duration and type of current course of biological therapy.ConclusionWith many descriptors being used infrequently and variations between medical and procedural literature, the colorectal community should assess the need for all 37 descriptors.

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Section: Resultsmentioning

confidence: 99%

The use of core descriptors from the ENiGMA code study in recent literature: a systematic review

Khan,

Arline,

Williams

et al. 2024

Colorectal Disease

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“…However, healing rates decline over time, and many patients require repeat interventions or definitive surgeries [19,20]. A recent report of 23 patients with CD managed with a long-term seton reported clinical response in only 40% of patients [21]. Similarly, the randomized PISA trial terminated early due to the long-term seton arm having a higher reintervention rate (10 of 15 patients), a finding not observed in its parallel nonrandomized registry [22].…”

Section: Discussion and Con Clus Ionsmentioning

confidence: 99%

Long‐term outcomes after seton placement for perianal fistulas with and without Crohn’s disease

et al. 2021

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Aim Perianal sepsis in Crohn's disease (CD) fistulas is managed with antibiotics and surgical drainage; a noncutting seton is used for an identified transsphincteric fistula tract. The optimal management following seton placement for initial control of perianal sepsis remains to be determined. Our main aim was to assess the success rates of curative surgery, seton removal or long‐term indwelling seton in patients with and without CD. Method This was a retrospective cohort of consecutive patients with a perianal fistula treated with a noncutting seton between 2010 and 2019, including 83 CD patients and 94 patients without CD. Initial control of symptomatic perianal infection with a seton and subsequent healing and reintervention rates were compared between the three postseton management strategies. Results A total of 177 patients, 61% male and 83.1% with complex fistulas, were followed for a median of 23 months (interquartile range 11–40 months). Immunomodulatory treatment was used in 90.4% of CD patients after seton placement. Good initial control of perianal infection was achieved with a seton in CD and non‐CD patients, at 92.9% and 96.7%, respectively (p = 0.11). Overall fistula healing or control for CD and non‐CD patients was, respectively, 64% and 86% (p = 0.1) after curative surgery, 49% and 71% after seton removal (p = 0.21) and 58% and 50% with long‐term seton placement (p = 0.72). Overall reintervention for recurrence was 83% in CD versus 53.1% in non‐CD patients during the follow‐up period (p = 0.002). Conclusion Definitive surgery was possible in only a minority of CD patients. Long‐term seton management was an effective option in patients with CD with acceptable improvement and recurrence rates.

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Advancing standard techniques for treatment of perianal fistula; when tissue engineering meets seton

Nazari

Soltani

Asbagh

et al. 2022

Health Sciences Review

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Outcomes of Definitive Draining Seton Placement for Complex Anal Fistula in Crohn’s Disease

Cited by 4 publications

References 14 publications

The use of core descriptors from the ENiGMA code study in recent literature: a systematic review

The use of core descriptors from the ENiGMA code study in recent literature: a systematic review

Long‐term outcomes after seton placement for perianal fistulas with and without Crohn’s disease

Advancing standard techniques for treatment of perianal fistula; when tissue engineering meets seton

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