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.

Beilinson Hospital Rabin Medical Center Ze'ev Jabotinsky Street 39 Petah Tikva Israel

Clinical Hospital Centre Zvezdara Preševska 31 Belgrade Serbia

Lithuanian University of Health Sciences Kaunas Clinics Eivenių G 2 Kaunas Lithuania

Military University Hospital U Vojenské Nemocnice 1200 Prague Czechia

Semmelweis University Üllői Út 26 Budapest Hungary

Takeda Pharmaceuticals d o o Bleiweisova Cesta 30 Ljubljana Slovenia

Tel Aviv University Ramat Aviv Tel Aviv Israel

University Clinical Centre of Serbia Pasterova 2 Belgrade Serbia

University Medical Centre Ljubljana Zaloška Cesta 2 Ljubljana Slovenia

University of Szeged Dugonics Tér 13 Szeged Hungary

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