title: Clinical advantages of combined seton placement and infliximab maintenance therapy for perianal fistulizing Crohn's disease: when and how were the seton drains removed?
abstract: OBJECTIVE
  Perianal fistulas are often found in patients with Crohn's Disease (CD), however, the complete management of such fistulas tends to be difficult. The aim of this study is to critically evaluate the clinical advantages of combined seton placement and infliximab maintenance therapy for perianal fistulizing CD.
  
  
  METHODS
  Fourteen patients (9 males, 5 females) were evaluated for perianal fistulizing CD with the seton and infliximab therapy. Almost all patients were examined for the presence of either an abscess or fistulas by computed tomography (CT) and/or Magnetic Resonance Imaging (MRI) in addition to their physical findings. Seton placement was performed under general anesthesia, following the administration of inflixmab at a dose of 5 mg/kg for weeks 0, 2 and 6, and then about every 8 weeks as a maintenance therapy.
  
  
  RESULTS
  For all patients average number of inserted drains was 4.5 and the average number of infliximab infusions was 9.4 times. The mean follow-up period was 12.1 months. A redness and/or swelling in perianal lesion were seen in 12 patients, moreover, pus discharge was seen in 7 patients, and serous exudate was seen in 7 patients. After the administration of these treatments, a reversal of the redness and/or swelling was seen in the exudate and a wet-to-dry wound change was found in all patients. Furthermore, the seton drains were completely removed in 11 patients. In most patients, seton drains were completely removed after 5 rounds of infliximab infusion. Following the removal of the seton drains from all the patients, they reported their post-treatment health and well-being to be good while also reporting a good quality of life (QOL). In addition, no serious adverse events were observed.
  
  
  CONCLUSIONS
  The combined seton placement and infliximab maintenance therapy for perianal fistulizing CD was therefore found to be effective in terms of fistula closure and the removal of seton drains. This treatment modality is therefore considered to be a safe clinical procedure which improves the QOL in patients with CD.
authors.affiliation: Department of Gastroenterological Surgery, Fukuoka University, School of Medicine Nanakuma 7-45-1, Jonan-ku, Fukuoka 814-0180, Japan. t-shin@fukuoka-u.ac.jp
authors.forename: Shinnosuke
authors.initials: S
authors.lastname: Tanaka
authors.forename: Katsuichi
authors.initials: K
authors.lastname: Matsuo
authors.forename: Takamitsu
authors.initials: T
authors.lastname: Sasaki
authors.forename: Masahiko
authors.initials: M
authors.lastname: Nakano
authors.forename: Koutarou
authors.initials: K
authors.lastname: Sakai
authors.forename: Richiko
authors.initials: R
authors.lastname: Beppu
authors.forename: Yuichi
authors.initials: Y
authors.lastname: Yamashita
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Maeda
authors.forename: Kunihiko
authors.initials: K
authors.lastname: Aoyagi
mesh_terms: D000293:Adolescent; D000328:Adult; D000911:Antibodies, Monoclonal / Q000008:administration & dosage*; D003131:Combined Modality Therapy; D003424:Crohn Disease / Q000473:pathology / Q000628:therapy*; D020878:Device Removal; D004322:Drainage / Q000295:instrumentation*; D004334:Drug Administration Schedule; D005260:Female; D005765:Gastrointestinal Agents / Q000008:administration & dosage*; D006801:Humans; D000069285:Infliximab; D008297:Male; D011788:Quality of Life; D012003:Rectal Fistula / Q000209:etiology / Q000473:pathology / Q000628:therapy*; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000911:Antibodies, Monoclonal; D005765:Gastrointestinal Agents; D000069285:Infliximab