Segment window exclusion plus cutting seton catheterization for treatment of complex anal fistula: Analysis of 128 cases

Objective: The aim of our study was to compare the success rates of suture selection, recovery times and pain associated with local wound infection and seton placement in patients undergoing cutting seton placement for complex anal fistula. Methods: The study included a total of 90 patients who were admitted with the diagnosis of complex anal fistula between January 2015 and July 2018. Results: The first session and other revision appointments demonstrated that the number of patients who required fistulotomy was significantly higher in group-1 as the seton failed to complete the transection (p = 0.001). When the patients were asked to rate pain for 3 different conditions according to numeric rating scale (NRS), the patients in group-2 had significantly higher pain in all 3 cases compared to the patients in group-1 (p = 0.001). The impact of the suture material on local infection was examined and it was determined that the results of cultures for seton material were significantly more positive in group-1 (p = 0.001). Conclusions: We conclude that a multi-stage tight seton placement with silk material can lead to satisfactory results by aiming to shorten the cutting time of silk seton. doi: https://doi.org/10.12669/pjms.36.4.1920 How to cite this:Akici M, Ersen O. The effect of suture selection in complex anal fistulas on the success of cutting seton placement and patient comfort. Pak J Med Sci. 2020;36(4):---------. doi: https://doi.org/10.12669/pjms.36.4.1920 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Complex anal fistulae management by combined technique approach: an experience

International Surgery Journal ◽

10.18203/2349-2902.isj20181129 ◽

2018 ◽

Vol 5 (4) ◽

pp. 1454

Author(s):

Shaileshkumar M. E. ◽

Sushanth P. T.

Keyword(s):

Anal Fistula ◽

Functional Disability ◽

Fistula Tract ◽

Complex Anal Fistula ◽

Source Of Infection ◽

Fistula Plug ◽

Intersphincteric Fistula ◽

Cutting Seton ◽

A Prospective Study ◽

Combined Technique

Background: The aim of this study is to evaluate our experience in the management of complex anal fistulae by combined technique approach. Ideal surgical treatment for complex anal fistula should aim to eradicate the source of infection and promote healing of the tract, while preserving the sphincters and the mechanism of anal continence. Even with the evolving newer techniques complex anal fistulae have higher rates of recurrence and functional disability as anal incontinence. The requirement of multiple surgeries for recurrence and the newer techniques like anal fistula plug are expensive and will become a burden for patients living in developing countries like ours. Thus, apart from Ligation of Intersphincteric fistula tract, the use of cutting seton is the main surgical method practiced here. This article focuses on the approach to the complex anal fistula management through evidence-based treatment strategies.Methods: Author conducted a prospective study of 35 complex anal fistulae patients undergoing combined technique approach with cutting Seton, Ligation of Intersphincteric Fistula tract and fistulotomy. Results: All patients recovered well with no complications in postoperative period. After 2 years of follow up patients are recurrence free and only 2 patients had partial incontinence with improving trend.Conclusions: The use of cutting Seton in high anal fistula is an effective technique. LIFT technique is good for Transphincteric tracts without previous scarring; it can be easily learned and applied. We can conclude that combined technique was an effective procedure and valid alternative for complex anal fistula management.

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