{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T03:25:27Z","timestamp":1791516327093,"version":"4.3.4"},"reference-count":67,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2016,7,4]],"date-time":"2016-07-04T00:00:00Z","timestamp":1467590400000},"content-version":"vor","delay-in-days":3,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Colorectal Disease"],"published-print":{"date-parts":[[2016,7]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Aim<\/jats:title><jats:p>The introduction of anti\u2010tumour necrosis factor (anti\u2010<jats:styled-content style=\"fixed-case\">TNF<\/jats:styled-content>; infliximab and adalimumab) has changed the management of Crohn's perianal fistula from almost exclusively surgical treatment to one with a much larger emphasis on medical therapy. The aim of this systematic review was to provide an overview of the success rates of setons and anti\u2010<jats:styled-content style=\"fixed-case\">TNF<\/jats:styled-content> for Crohn's perianal fistula.<\/jats:p><\/jats:sec><jats:sec><jats:title>Method<\/jats:title><jats:p>Studies evaluating the effect of setons and anti\u2010<jats:styled-content style=\"fixed-case\">TNF<\/jats:styled-content> on Crohn's perianal fistula were included. Studies assessing perianal fistula in children, rectovaginal and rectourinary fistulae were excluded. The primary end\u2010point was the fistula closure rate. Partial closure and recurrence rates were secondary end\u2010points.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Ten studies on seton drainage were included (<jats:italic>n\u00a0<\/jats:italic>=<jats:italic>\u00a0<\/jats:italic>305). Complete closure varied from 13.6% to 100% and recurrence from 0% to 83.3%. In 34 anti\u2010<jats:styled-content style=\"fixed-case\">TNF<\/jats:styled-content> studies (<jats:italic>n\u00a0<\/jats:italic>=<jats:italic>\u00a0<\/jats:italic>1449), complete closure varied from 16.7% and 93% (partial closure 8.0\u201391.2%) and recurrence from 8.0% to 40.9%. Four randomized controlled trials (<jats:italic>n\u00a0<\/jats:italic>=<jats:italic>\u00a0<\/jats:italic>1028) comparing anti\u2010<jats:styled-content style=\"fixed-case\">TNF<\/jats:styled-content> with placebo showed no significant difference in complete or partial closure in meta\u2010analysis (risk difference 0.12, 95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content> \u22120.06 to 0.30 and 0.09, 95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content> \u22120.23 to 0.41, respectively). Subgroup analysis (<jats:italic>n\u00a0<\/jats:italic>=<jats:italic>\u00a0<\/jats:italic>241) showed a significant advantage for complete fistula closure with anti\u2010<jats:styled-content style=\"fixed-case\">TNF<\/jats:styled-content> in two trials with follow\u2010up &gt;\u00a04\u00a0weeks (46% <jats:italic>vs<\/jats:italic> 13%, <jats:italic>P\u00a0<\/jats:italic>=<jats:italic>\u00a0<\/jats:italic>0.003 and 30% <jats:italic>vs<\/jats:italic> 13%, <jats:italic>P\u00a0<\/jats:italic>=<jats:italic>\u00a0<\/jats:italic>0.03). Of four included cohort studies, two revealed a significant difference in response in favour of combined treatment (<jats:italic>P\u00a0<\/jats:italic>=<jats:italic>\u00a0<\/jats:italic>0.001 and <jats:italic>P\u00a0<\/jats:italic>=<jats:italic>\u00a0<\/jats:italic>0.014).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Closure and recurrence rates after seton drainage as well as anti\u2010<jats:styled-content style=\"fixed-case\">TNF<\/jats:styled-content> vary widely. Despite a large number of studies, no conclusions can be drawn regarding the preferred strategy. However, combination therapy with (temporary) seton drainage, immunomodulators and anti\u2010<jats:styled-content style=\"fixed-case\">TNF<\/jats:styled-content> may be beneficial in achieving perianal fistula closure.<\/jats:p><\/jats:sec>","DOI":"10.1111\/codi.13311","type":"journal-article","created":{"date-parts":[[2016,2,27]],"date-time":"2016-02-27T15:22:29Z","timestamp":1456586549000},"page":"667-675","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":112,"title":["Treatment of perianal fistula in Crohn's disease: a systematic review and meta\u2010analysis comparing seton drainage and anti\u2010tumour necrosis factor treatment"],"prefix":"10.1111","volume":"18","author":[{"given":"E. 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