Long-term seton drainage as a definitive treatment for perianal fistulas in Crohn's disease: A systematic review and meta-analysis

초록

Perianal fistulizing Crohn's disease (PFCD) poses substantial treatment challenges due to its intricate pathology and high recurrence rates. Definitive draining seton (DDS), defined by the prolonged placement of a seton exceeding six months, has emerged as a promising therapeutic strategy aimed at controlling sepsis, preserving sphincter integrity, and alleviating symptoms. DDS can function as either definitive treatment or a transitional approach towards subsequent surgical interventions. This systematic review and meta-analysis, conducted according to PRISMA guidelines, evaluated the efficacy and safety of DDS in managing PFCD. An extensive database search from January 1980 to July 2024 identified 26 studies involving 835 patients, predominantly with complex or trans-sphincteric fistulas. The pooled success rate, defined as symptom improvement or fistula closure, was 62.12 % (95 % CI: 52.51-71.73); when restricted to complete fistula closure, the pooled rate was 59.38 % (95 % CI 38.37-80.39). Sensitivity analyses indicated minor fluctuations in outcomes based on concurrent medical therapies, especially anti-TNF treatments, study participant numbers, and quality scores, yielding success rates between 53.94 % and 57.45 %. Reported incontinence rates were generally low, ranging from 0 % to 12 %. Comparative analyses demonstrated slightly less favorable outcomes for DDS (log OR: 0.80, 95 % CI: 0.27-1.32) compared to other surgical methods. Nonetheless, its minimally invasive characteristics, favorable continence preservation, and dual role as definitive or bridge therapy reinforce DDS as a significant therapeutic option for PFCD. (c) 2026 Asian Surgical Association and Taiwan Society of Coloproctology. Publishing services by Elsevier B.V. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/ by-nc-nd/4.0/).

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