Evidence map›Paper›PMID 41219674›Full record

SynthesisDigestive diseases and sciences2026

Fistula Outcomes After Seton Removal in Patients with Perianal Fistulizing Crohn's Disease: A Systematic Review and Meta-Analysis.

Edgard Medawar, Kevin Chin Koon Siw, Amine Zoughlami, Malik Ekhdoura, Widad Safih, Shyla Gupta, Serre-Yu Wong, Parakkal Deepak, Alyssa M Parian, Paulo Gustavo Kotze and 1 more

Abstract readSystematic ReviewMeta-Analysis
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In one paragraph

Synthesis in Digestive diseases and sciences, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

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0citing papers in PubMed
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1 · What the graph read from it

What it found

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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

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Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

0 citing papers in PubMed.

No citing paper in PubMed yet.

4 · The record

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5 · Who and what money

Authors and funding

11 authors.

Edgard MedawarDepartment of Medicine, University of Ottawa, Ottawa, ON, Canada. epmedawar@gmail.com.
Kevin Chin Koon SiwDivision of Gastroenterology and Hepatology, The Ottawa Hospital, Ottawa, ON, Canada.
Amine ZoughlamiDivision of Gastroenterology, McGill University Health Centre, Montreal, QC, Canada.
Malik EkhdouraDepartment of Medicine, University of Ottawa, Ottawa, ON, Canada.
Widad SafihDepartment of Medicine, University of Sherbrooke, Sherbrooke, QC, Canada.
Shyla GuptaDepartment of Medicine, University of Ottawa, Ottawa, ON, Canada.
Serre-Yu WongThe Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
Parakkal DeepakDivision of Gastroenterology, Washington University in St. Louis School of Medicine, St. Louis, MO, USA.
Alyssa M ParianDivision of Gastroenterology and Hepatology, Johns Hopkins School of Medicine, Baltimore, MD, USA.
Paulo Gustavo KotzeColorectal Surgery Unit, Pontificia Universidade Catolica do Paraná, Curitiba, Brazil.
Jeffrey D McCurdyDepartment of Medicine, University of Ottawa, Ottawa, ON, Canada.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundWhile setons are commonly used in the multidisciplinary care of patients with perianal fistulizing Crohn's disease (PFCD), fistula outcomes after their removal are poorly understood. We performed a systematic review with meta-analysis to evaluate fistula outcomes after seton removal in patients with PFCD.

methodsMEDLINE, EMBASE, Web of Science, and Cochrane databases were systematically searched until December 2023. We included studies reporting fistula outcomes after seton removal in PFCD. We used a hierarchy to stratify patients into one of three treatment categories: medical therapy alone, surgical closure, or cell/plasma-based therapy. Fistula outcomes were reported as weighted proportions with 95% confidence intervals (CI).

resultsEighty-two studies (n = 2441 patients) were analyzed. Mean/median seton duration varied widely (2 to 70 weeks). Pooled estimates (95% CI) of fistula outcomes after seton removal for patients treated in the medical therapy alone, surgical closure, or cell/plasma-based therapy categories were, respectively, 64% (54-75), 65% (52-78), and 71% (65-77) for fistula remission; 30% (22-38), 29% (16-42), and 20% (15-25) for recurrence; 15% (8-22), 11% (4-20), and 14% (8-21) for abscess formation; and 26% (18-35), 23% (17-29), and 13% (2-26) for surgical re-intervention. Fistula outcome estimates remained stable in multiple sensitivity analyses. Limited studies directly compared fistula outcomes based on seton duration, yielding inconsistent results.

conclusionsThis systematic review provides comprehensive estimates of fistula outcomes after seton removal and demonstrates substantial variability in seton duration. Future research is required to determine the optimal duration of setons.

Indexed as

Crohn DiseaseRectal FistulaHumansTreatment OutcomeAnal fistulaBiologic therapyCrohn’s diseaseDrainageMesenchymal stem cells

Identifiers

PMID41219674

What OpenQuestion holds

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.