{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,9,11]],"date-time":"2025-09-11T21:03:39Z","timestamp":1757624619823,"version":"3.44.0"},"reference-count":6,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2025,8,25]],"date-time":"2025-08-25T00:00:00Z","timestamp":1756080000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,8,25]],"date-time":"2025-08-25T00:00:00Z","timestamp":1756080000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100002911","name":"Universidad Complutense de Madrid","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100002911","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Int J Colorectal Dis"],"abstract":"<jats:title>Abstract<\/jats:title>\n          <jats:sec>\n            <jats:title>Purpose<\/jats:title>\n            <jats:p>To determine how seton configuration, thickness, and laxity influence patient comfort and clinical outcomes in the management of chronic perianal fistulas.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods<\/jats:title>\n            <jats:p>A prospective single-center study was conducted involving 33 patients (53 setons). Both intraindividual paired (n\u2009=\u200920) and independent group analyses (n\u2009=\u200913) were performed. Setons were categorized by configuration (O-shaped vs. V-shaped), thickness (1.5\u00a0mm vs. 2.5\u00a0mm), and laxity (\u2264\u20092\u00a0cm vs.\u2009&gt;\u20092\u00a0cm from the anal verge). Patient-reported outcomes were assessed using structured questionnaires evaluating sitting discomfort, discharge, sexual impact, and fecal incontinence.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results<\/jats:title>\n            <jats:p>O-shaped setons caused significantly less sitting discomfort than V-shaped ones (50.0% vs. 80.0%, p\u2009=\u20090.021). Excess laxity (&gt;\u20092\u00a0cm) was associated with increased discharge (86.4% vs. 51.6%, p\u2009=\u20090.008), sexual impact (42.1% vs. 10.3%, p\u2009=\u20090.016), and fecal incontinence (66.7% vs. 10.0%, p\u2009=\u20090.041). Thicker setons (2.5\u00a0mm) showed a non-significant trend toward more pain (42.9% vs. 17.9%, p\u2009=\u20090.080).<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusion<\/jats:title>\n            <jats:p>Seton configuration and laxity significantly affect patient comfort. O-shaped setons and shorter laxity (\u2264\u20092\u00a0cm) are preferable for reducing discomfort. These findings support evidence-based seton selection, although larger multicenter studies are needed to confirm these results.\n<\/jats:p>\n          <\/jats:sec>","DOI":"10.1007\/s00384-025-04985-9","type":"journal-article","created":{"date-parts":[[2025,8,25]],"date-time":"2025-08-25T14:17:17Z","timestamp":1756131437000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Influence of seton configuration, thickness, and laxity on patient comfort in chronic perianal fistula: a prospective comparative study"],"prefix":"10.1007","volume":"40","author":[{"given":"J","family":"Barambio","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ana","family":"Leon-Bretscher","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mar\u00eda","family":"Ram\u00edrez Bescos","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Paula","family":"Soto Garc\u00eda","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Paloma","family":"Gadea Uria","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Teresa","family":"Laloumet Garcimartin","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Elena","family":"Viejo Martinez","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Felipe","family":"Acedo Fernandez de Pedro","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Patricia","family":"Ortega Domene","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alicia","family":"Ruiz de la Hermosa","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mar\u00eda Luisa","family":"De Fuenmayor-Valera","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gloria","family":"Paseiro-Crespo","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2025,8,25]]},"reference":[{"key":"4985_CR1","unstructured":"Jimenez M, Mandava N (2025) Anorectal fistula. In: StatPearls. StatPearls Publishing, Treasure Island (FL)"},{"issue":"12","key":"4985_CR2","first-page":"e11882","volume":"12","author":"SH Feroz","year":"2020","unstructured":"Feroz SH, Ahmed A, Muralidharan A, Thirunavukarasu P (2020) Comparison of the efficacy of the various treatment modalities in the management of perianal crohn\u2019s fistula: a review. Cureus 12(12):e11882","journal-title":"Cureus"},{"issue":"28","key":"4985_CR3","doi-asserted-by":"publisher","first-page":"3277","DOI":"10.3748\/wjg.v17.i28.3277","volume":"17","author":"S Shawki","year":"2011","unstructured":"Shawki S, Wexner SD (2011) Idiopathic fistula-in-ano. World J Gastroenterol 17(28):3277\u20133285","journal-title":"World J Gastroenterol"},{"issue":"3","key":"4985_CR4","doi-asserted-by":"publisher","first-page":"221","DOI":"10.1007\/s00104-023-02011-8","volume":"95","author":"D Sterzing","year":"2024","unstructured":"Sterzing D (2024) On fistulas and threads\u202f: sense and nonsense of seton drainage. Chirurgie (Heidelb) 95(3):221\u2013228","journal-title":"Chirurgie (Heidelb)"},{"issue":"4","key":"4985_CR5","doi-asserted-by":"publisher","first-page":"122","DOI":"10.23922\/jarc.2017-044","volume":"2","author":"N Saigusa","year":"2018","unstructured":"Saigusa N, Saigusa JI, Shinozaki M, Yokoyama T, Yokoi Y, Takami H et al (2018) A series of seton techniques involving \u201ctop-down therapy\u201d for patients with Crohn\u2019s disease who initially presented with perianal fistulas. J Anus Rectum Colon 2(4):122\u2013129","journal-title":"J Anus Rectum Colon"},{"issue":"1","key":"4985_CR6","doi-asserted-by":"publisher","first-page":"77","DOI":"10.1007\/BF02050307","volume":"36","author":"JM Jorge","year":"1993","unstructured":"Jorge JM, Wexner SD (1993) Etiology and management of fecal incontinence. Dis Colon Rectum 36(1):77\u201397. https:\/\/doi.org\/10.1007\/BF02050307","journal-title":"Dis Colon Rectum"}],"container-title":["International Journal of Colorectal Disease"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00384-025-04985-9.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00384-025-04985-9\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00384-025-04985-9.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,9,9]],"date-time":"2025-09-09T14:35:07Z","timestamp":1757428507000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00384-025-04985-9"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,8,25]]},"references-count":6,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2025,12]]}},"alternative-id":["4985"],"URL":"https:\/\/doi.org\/10.1007\/s00384-025-04985-9","relation":{},"ISSN":["1432-1262"],"issn-type":[{"type":"electronic","value":"1432-1262"}],"subject":[],"published":{"date-parts":[[2025,8,25]]},"assertion":[{"value":"10 June 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"12 August 2025","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"25 August 2025","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"All authors declare no financial relationships relevant to this study.All authors declare no financial relationships relevant to this study.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Financial Disclosures"}},{"value":"The data that support the findings of this study are available from the corresponding author upon reasonable request. Access to de-identified patient data will be granted to researchers with a methodologically sound proposal, following institutional and ethical guidelines. Requests should be directed to analeonbre@gmail.com.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Data Sharing Statement"}},{"value":"The authors declare no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"187"}}