Treatment of complex perianal fistulas with seton and infliximab in adolescents with Crohn's disease.
OBJECTIVE
Treatment of complex perianal fistulas associated with Crohn's disease is challenging. In adults, seton drainage combined with infliximab therapy has proven to be more effective than either one alone. Results following such treatment among pediatric patients have not been reported previously. The aim of this study was to describe outcomes after combined seton and infliximab treatment for complex perianal fistulas in adolescents with Crohn's disease.


METHODS
We performed a retrospective medical record review of all consecutive Crohn's disease patients treated for perianal fistulas with seton drainage and infliximab between 2007 and 2013 (n=13). A follow-up interview was conducted at median of two years.


RESULTS
Median age at fistula diagnosis was 14years. Following seton placement in fistula tracks, infliximab induction was administered at weeks 0, 2, and 6 and maintenance therapy at 8-week intervals. Over 90% responded to seton drainage and infliximab induction. Final fistula response was obtained at median of 8weeks, being complete in 77% and partial in 15%. Setons were kept in place for median of 8months. Fistulas recurred in 23% over a year after the final response. At last follow-up, 85% still had a response and 70% were free from perianal symptoms. Most were still on anti-TNF-α therapy, but one third had switched to adalimumab. Patients' anorectal function was well preserved and overall satisfaction with the treatment was high.


CONCLUSIONS
The results suggest that combining seton drainage with infliximab therapy improves the perianal fistula response rates in pediatric patients.
Pediatric Liver and Gut Research Group, Section of Pediatric Surgery, Children's Hospital, University of Helsinki, Finland. Electronic address: maria.hukkinen@helsinki.fi.
Maria
M
Hukkinen
Pediatric Liver and Gut Research Group, Section of Pediatric Surgery, Children's Hospital, University of Helsinki, Finland.
Mikko P
MP
Pakarinen
Section of Pediatric Gastroenterology, Children's Hospital, University of Helsinki, Finland.
Maija
M
Piekkala
Section of Pediatric Surgery, Children's Hospital, University of Helsinki, Finland.
Antti
A
Koivusalo
Section of Pediatric Surgery, Children's Hospital, University of Helsinki, Finland.
Risto
R
Rintala
Section of Pediatric Gastroenterology, Children's Hospital, University of Helsinki, Finland.
Kaija-Leena
KL
Kolho
D000293:Adolescent; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects / Q000627:therapeutic use*; D000911:Antibodies, Monoclonal / Q000009:adverse effects / Q000627:therapeutic use*; D003131:Combined Modality Therapy; D003424:Crohn Disease / Q000150:complications* / Q000188:drug therapy; D004322:Drainage / Q000379:methods; D005260:Female; D006801:Humans; D000069285:Infliximab; D008297:Male; D012003:Rectal Fistula / Q000188:drug therapy / Q000209:etiology / Q000628:therapy*; D012189:Retrospective Studies; D013536:Suture Techniques; D016896:Treatment Outcome
D000894:Anti-Inflammatory Agents, Non-Steroidal; D000911:Antibodies, Monoclonal; D000069285:Infliximab
Anti-TNF-α therapy; Complex perianal fistulas; Pediatric Crohn's disease; Perianal Crohn's disease; Seton drainage