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Background <p>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.</p> Methods <p>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).</p> Results <p>Eighty-two studies (<i>n</i> = 2441 patients) were analyzed. Mean/median seton duration varied widely (2 to 70&#xa0;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.</p> Conclusions <p>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.</p>

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Fistula Outcomes After Seton Removal in Patients with Perianal Fistulizing Crohn’s Disease: A Systematic Review and Meta-Analysis

  • 期刊论文

  • 发表日期：

    2025年11月11日

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  • Edgard Medawar,
  • Kevin Chin Koon Siw,
  • Amine Zoughlami,
  • Malik Ekhdoura,
  • Widad Safih,
  • Shyla Gupta,
  • Serre-Yu Wong,
  • Parakkal Deepak,
  • Alyssa M. Parian,
  • Paulo Gustavo Kotze,
  • Jeffrey D. McCurdy

摘要

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.