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

摘要

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 withCrohn disease between January 2014 and November 2017. All patients underwent loose seton drainage combined withIFX therapy. Patients categorized as the early group (EG, 49 patients) received IFX therapy within 30 days of completionof the seton procedure. Patients categorized as the late group (LG, 27 patients) received IFX therapy 30 days after the setonprocedure. IFX therapy was administered as induction and maintenance therapy.Results: There were no statistically significant intergroup differences in clinical characteristics of the patients. The meanfollow-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 setonprocedure and IFX induction therapy was 12.2 days in the EG and 250.2 days in the LG (P = 0.002). Complete remissionwas observed in 32 patients (65.3%) in the EG and 17 patients (63.0%) in the LG (P = 0.844). Fistula recurrence wasobserved 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 ofinitiation of IFX therapy.