Complex perianal fistula is a common complication of Crohn's disease (CD) which leads
to negative impact on patient's quality of life. Successful management of the disease
requires a multidisciplinary approach, including a gastroenterologist and a colorectal
surgeon, applying combined surgical and medical therapy. One of frequently practiced
surgical procedures is seton placement in the fistula tract, which is used to control
perianal sepsis and drain the fistula, while preventing recurrent abscess formation.Darvadstrocel,
a suspension of expanded, allogeneic, adipose-derived, mesenchymal stem cells, is
safe and effective for treatment-refractory complex perianal fistulas in patients
with Crohn's disease. Following approval of darvadstrocel, the INSPIRE registry is
being conducted in order to evaluate long-term safety and effectiveness of the drug
on a large, heterogenous population.An online expert meeting was held from March 20
to March 30, 2023, which provided relevant insights into the decision-making process
regarding seton use and obtained feedback on the first experiences with darvadstrocel.
The aim of this article is to present the perspectives from gastroenterologists and
colorectal surgeons practicing in Czechia, Hungary, Israel, Lithuania, Serbia, and
Slovenia in topics such as diagnosis and treatment options for patients with complex
Crohn's perianal fistulas (CPF), specifically focusing on the use of setons and darvadstrocel.During
this virtual session, unavailability of comprehensive data on safety and efficacy
of available treatment procedures was emphasized as an important obstacle towards
development of standardized recommendations and improvement of outcomes in treatment
of (CPF). Furthermore, achieving consensus in seton use, duration of its placement,
and frequency of change is recognized as one of CPF treatments major challenges. Despite
these issues, it is important to promote better understanding and treatment of complex
perianal fistulas in order to improve the quality of life of those affected by this
condition.
