Similar outcomes for anti-tumor necrosis factor-α antibody and immunosuppressant following seton drainage in patients 
with Crohn's disease-related anal fistula

Lin,Xutao; Fan,Dejun; Cai,Zerong; Lian,Lei; He,Xiaowen; Zhi,Min; Wu,Xiaojian; He,Xiaosheng; Lan,Ping

doi:10.3892/etm.2016.3552

Similar outcomes for anti-tumor necrosis factor-α antibody and immunosuppressant following seton drainage in patients with Crohn's disease-related anal fistula

Authors:
- Xutao Lin
- Dejun Fan
- Zerong Cai
- Lei Lian
- Xiaowen He
- Min Zhi
- Xiaojian Wu
- Xiaosheng He
- Ping Lan
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Affiliations: Department of Colorectal Surgery, The Sixth Affiliated Hospital, Sun Yat‑Sen University, Guangzhou, Guangdong 510655, P.R. China, Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat‑Sen University, Guangzhou, Guangdong 510655, P.R. China
Published online on: July 26, 2016 https://doi.org/10.3892/etm.2016.3552
Pages: 1939-1945

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Abstract

Anal fistula is common in patients with Crohn's disease (CD) and leads to significant morbidity. The efficacy of seton drainage combined with anti-tumor necrosis factor‑α monoclonal antibody (anti‑TNF‑α) or immunosuppressant in the treatment of CD‑related anal fistula remains unclear. The aim of the present study was to compare the efficacy between seton drainage combined with anti-TNF-α and seton drainage combined with immunosuppressant postoperatively on the treatment of CD‑related anal fistula. A total of 65 patients with CD‑related anal fistula who had received seton drainage combined with postoperative medication were divided into an antibiotics only group, anti‑TNF‑α group and immunosuppressant group; all patients were treated with antibiotics. Fistula closure, external orifice exudation rate and recurrence rate were assessed among these patients. The duration of follow‑up ranged from 3 to 84 months with an average of 25.3 months. There were 11 (16.9%) cases of recurrence after seton drainage, 9 of which underwent a second seton drainage. In the total study group, 34 (52.3%) cases achieved complete fistula closure, and 10 (15.4%) cases showed external orifice exudation. No significant difference was found among these three groups, regarding fistula closure rate, closure time of fistula and recurrence rate. The external orifice exudation rate was significantly higher in the anti-TNF-α group compared with the antibiotics only group and immunosuppressant group (P=0.004 and P=0.026, respectively). Seton drainage is an effective treatment for CD‑related anal fistula. The efficacy is similar whether combined with anti-TNF-α or immunosuppressant.

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