PERIANAL FISTULIZING CROHN'S DISEASE IN REMISSION: WHAT HAPPENS TO THE FISTULA AFTER REMOVAL OF THE SETON?

Introduction The surgical treatment of perianal fistulizing Crohn's disease (PCD) initially involves abscess drainage, seton placement, and in very severe cases, intestinal diversion. After scheduled surgeries to control the damage in conjunction with biological therapy, and in the presence of perianal remission, the surgical team may perform procedures such as fistulotomy, mucosal advancement, LIFT, or VAFT with the goal of treating the fistula. In this context, removal of the seton without any definitive treatment may be a therapeutic option.

Objective To evaluate the evolution of the anorectal fistula in fistulizing Crohn's disease after seton removal.

Method This study was conducted through a review of medical records containing information about seton removal during the last surgery for the treatment of PCD between 12/2021 and 03/2024. The demographic data studied included age, sex, and Montreal classification. The number of surgical procedures up to the surgery for seton removal was quantified. Patients with fistulas of other etiologies or those lost to follow-up were excluded.

Results During the study period, 47 patients were operated on due to PCD, of which 19 underwent seton removal and curettage of the fistula tract. The average age was 32 years, with a predominance of male patients (58%). Patients underwent an average of three surgical procedures (ranging from two to seven) from seton placement to removal. The average duration of seton placement was 13.6 months (ranging from two to 36 months). The majority of patients (13) had only one fistula tract. Fistula obliteration occurred in 69%, while 21% showed an epithelialized and asymptomatic fistula. Recurrence of inflammatory activity in the fistula tract was diagnosed in 10% of patients within six months of seton removal.

Conclusion In this study, seton removal was effective, allowing fistula tract obliteration in 69% of patients. Only 10% of patients showed recurrence of inflammatory activity in the fistula tract within six months after the seton removal surgery. This is considered an appropriate therapeutic option for patients who have achieved perianal remission.

No conflict of interest has been declared by the author(s).

Publication History

Article published online:
25 April 2025