Surgical outcomes of perianal fistulas in Crohn's disease treated with draining seton

Aim

to evaluate the outcomes of surgery for perianal fistulas using draining seton in perianal fistulizing Crohn's disease (CD). P ATIENT S AND

Methods

retrospective study included 199 patients with perianal fistulas associated with CD who underwent surgical treatment with draining latex seton placement between February 2017 and October 2024. Transrectal ultrasound (TRUS) of the rectum was performed for preoperative and postoperative imaging. The endpoints included positive response to treatment and partial improvement rate, primary treatment failure, recurrence rate, and rate of reinterventions. RESULT S: positive response to treatment, according to predefined criteria, was achieved in 121/199 (61%) patients. A second surgical stage was performed in 89/121 (74%) patients, with a median interval of 12 months (IQR: 7–18) between procedures. Recurrence occurred in 7/121 (6%) patients, with a median time to recurrence of 14 months (IQR: 11–16). In 32/199 (16%) cases, a partial improvement was noted — a decrease in the size of the collections or their number. Primary failure due to persistent undrained collections was diagnosed in 46/199 (23%) patients. In 25 (54%) of these cases, progression of perianal disease was noted postoperatively, characterized by new fistula tracts and enlargement of existing collections. Repeat drainage with seton placement was performed in 33/46 (72%) patients. In 11/46 (24%) cases, due to an aggressive disease course, an abdominoperineal resection (APR) was performed.

Conclusion

the results largely confirm that draining seton placement is only one component of a multimodal strategy for perianal Crohn's disease (pCD). Therefore, further studies are warranted to identify and analyze factors influencing healing, recurrence, and progression rates of perianal fistulas.