Ann Coloproctol.  2019 Oct;35(5):249-253. 10.3393/ac.2018.11.23.1.

Evaluation of a Seton Procedure Combined With Infliximab Therapy (Early vs. Late) in Perianal Fistula With Crohn Disease

Affiliations
  • 1Department of Surgery, Goo Hospital, Daegu, Korea.
  • 2Department of Surgery, Yeungnam University Medical Center, Yeungnam University College of Medicine, Daegu, Korea. kshgs@yu.ac.kr

Abstract

PURPOSE
We assessed the clinical outcomes of a seton procedure combined with early versus late institution of infliximab (IFX) therapy.
METHODS
This retrospective study comprised 76 patients who underwent surgery for perianal fistula associated with Crohn disease between January 2014 and November 2017. All patients underwent loose seton drainage combined with IFX therapy. Patients categorized as the early group (EG, 49 patients) received IFX therapy within 30 days of completion of the seton procedure. Patients categorized as the late group (LG, 27 patients) received IFX therapy >30 days after the seton procedure. IFX therapy was administered as induction and maintenance therapy.
RESULTS
There were no statistically significant intergroup differences in clinical characteristics of the patients. The mean follow-up was 21.0 ± 11.6 months in the EG and 34.5 ± 18.4 months in the LG (P = 0.001). The mean interval between seton procedure and IFX induction therapy was 12.2 days in the EG and 250.2 days in the LG (P = 0.002). Complete remission was observed in 32 patients (65.3%) in the EG and 17 patients (63.0%) in the LG (P = 0.844). Fistula recurrence was observed in 6 patients (7.9%). All recurrences occurred in a previous perianal fistula tract.
CONCLUSION
Patients showed a good response to a seton procedure combined with IFX therapy regardless of the time of initiation of IFX therapy.

Keyword

Crohn disease; Infliximab; Perianal fistula; Seton

MeSH Terms

Crohn Disease*
Drainage
Fistula*
Follow-Up Studies
Humans
Infliximab*
Recurrence
Retrospective Studies
Infliximab
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