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Published on: March 12, 2019
Fistula Outcomes After Seton Removal in Patients with Perianal Fistulizing Crohn's Disease: A Systematic Review and
Edgard Medawar1,2, Kevin Chin Koon Siw3, Amine Zoughlami4
1Department of Medicine, University of Ottawa, Ottawa, ON, Canada. epmedawar@gmail.com.
Background:
While setons are commonly used in the multidisciplinary care of patients with perianal fistulizing Crohn's disease (PFCD), fistula outcomes after their removal are poorly understood. We performed a systematic review with meta-analysis to evaluate fistula outcomes after seton removal in patients with PFCD.
Methods:
MEDLINE, EMBASE, Web of Science, and Cochrane databases were systematically searched until December 2023. We included studies reporting fistula outcomes after seton removal in PFCD. We used a hierarchy to stratify patients into one of three treatment categories: medical therapy alone, surgical closure, or cell/plasma-based therapy. Fistula outcomes were reported as weighted proportions with 95% confidence intervals (CI).
Results:
Eighty-two studies (n = 2441 patients) were analyzed. Mean/median seton duration varied widely (2 to 70 weeks). Pooled estimates (95% CI) of fistula outcomes after seton removal for patients treated in the medical therapy alone, surgical closure, or cell/plasma-based therapy categories were, respectively, 64% (54-75), 65% (52-78), and 71% (65-77) for fistula remission; 30% (22-38), 29% (16-42), and 20% (15-25) for recurrence; 15% (8-22), 11% (4-20), and 14% (8-21) for abscess formation; and 26% (18-35), 23% (17-29), and 13% (2-26) for surgical re-intervention. Fistula outcome estimates remained stable in multiple sensitivity analyses. Limited studies directly compared fistula outcomes based on seton duration, yielding inconsistent results.
Conclusions:
This systematic review provides comprehensive estimates of fistula outcomes after seton removal and demonstrates substantial variability in seton duration. Future research is required to determine the optimal duration of setons.
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