Perianal sepsis in Crohn’s fistulae is managed with antibiotics and surgical drainage; a non-cutting seton is used for an identified trans-sphincteric fistula tract. Optimal management following seton placement for initial control of perianal sepsis remains to be determined. Our main objective was to assess success rates of curative surgery, seton removal, or long-term indwelling seton in patients with and without Crohn’s.
This was a retrospective cohort of consecutive patients with a perianal fistula treated with a non-cutting seton between 2010-2019, including 83 Crohn’s patients and 94 patients without Crohn’s. Initial control of symptomatic perianal infection with seton and subsequent healing and reintervention rates were compared between the three post-seton management strategies.
177 patients, 61% male and 83.1% with complex fistulae were followed for a median of 23 months [interquartile range 11-40]. Immunomodulatory treatment was used in 90.4% of Crohn’s patients after seton placement. Good initial control of perianal infection with seton was achieved in Crohn’s and non-Crohn’s patients, 92.9% and 96.7%, respectively (p=0.11). Overall fistula healing or control for Crohn’s and non-Crohn’s patients, was 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 Crohn’s versus 53.1% in non-Crohn’s patients during the follow-up period (p=0.002).
Definitive surgery was possible only in a minority of Crohn’s patients. Long-term seton management was an effective option in patients with Crohn’s disease with acceptable improvement and recurrence rates.

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