In patients with a high-output perianal abscess after abdominoperineal resection, is a cutting seton or a temporary diverting stoma preferred for drainage control

What is known

- ACPGBI consensus rejected cutting setons in fistulating perianal Crohn's; 90% of UK surgeons would never use one due to future incontinence risk. ¹ - Cutting setons yield low recurrence but cause incontinence in up to two-thirds of patients. ² - Non-cutting setons maintain drainage, prevent recurrent abscess, and preserve sphincter function; improvement in 79-100% of patients. ^3,4 - A temporary diverting stoma is used when drainage/setons cannot control perianal sepsis or systemic toxicity persists. ^3,5

What is unknown / caveats

- Fecal diversion has no level-A support and healing rates are only ~40% - Retrieved evidence addresses perianal/perineal Crohn's fistula-abscess management, not specifically an abscess in the perineal wound after abdominoperineal resection (APR) - No head-to-head cutting-seton vs diverting-stoma comparison exists — the two are not competing options for the same clinical problem - Diversion is often not reversed: 53-87% of diverted patients retain the stoma permanently - The excerpts do not address a post-APR perineal abscess specifically, where there is no anal sphincter or fistula tract for a seton in the conventional sense.

## References

1. [No authors listed]. Association of Coloproctology of Great Britain and Ireland consensus exercise on surgical management of fistulating perianal Crohn's disease. Colorectal Dis. 2017;19(5):418-429. PMID: 28387062.

2. Sica GS, Di Carlo S, Tema G, Montagnese F, Del Vecchio Blanco G, Fiaschetti V, Maggi G, Biancone L. Treatment of peri-anal fistula in Crohn's disease. World J Gastroenterol. 2014;20(37):13205-10. PMID: 25309057.

3. Sordo-Mejia R, Gaertner WB. Multidisciplinary and evidence-based management of fistulizing perianal Crohn's disease. World J Gastrointest Pathophysiol. 2014;5(3):239-51. PMID: 25133026.

4. Kelley KA, Kaur T, Tsikitis VL. Perianal Crohn's disease: challenges and solutions. Clin Exp Gastroenterol. 2017;10:39-46. PMID: 28223835.

5. [No authors listed]. Management of Complex Anorectal and Perianal Crohn's Disease. Clin Colon Rectal Surg. 2019;32(4):255-260. PMID: 31275071.

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_Draft — generated by the IBDology RAG and not yet clinician-reviewed. Answers are grounded in the retrieved literature listed above; a high faithfulness score means the answer matches its sources, not that the sources are correct._