Abstract
BackgroundThe aim of this study was to evaluate our experience in managing high anal fistulas with a simple modification of the cutting seton.MethodsWe performed a retrospective review of standardized patient charts and of prospectively collected scores and questionnaires. Surgical outcomes of 128 consecutive, well-documented patients with high anal fistulas, including anterior transsphincteric fistulas in females, treated using a hybrid seton, were analyzed.ResultsNo significant complications occurred. The mean postoperative pain scores on a visual analog scale were 3.23 and 0.61, on days 1 and 7, respectively. Complete healing was achieved in 67 cases (52.3 %) at 1 month and in all cases (100 %) at 3 months. Recurrent fistula was noted in 2 patients (1.5 %) at 6 and 12 months. The mean postoperative incontinence scores at 3 and 12 months did not differ significantly from the preoperative score (p = 0.061, Wilcoxon’s test). The depression, life style, and embarrassment item scores of the fecal incontinence quality of life index improved significantly after surgical treatment.ConclusionsThe results of this series suggest that the hybrid seton might be a valid alternative for the treatment of high anal fistulas, eliminating the need for postoperative adjustments. The slow and stable cutting of the sphincter seems to have a positive effect on the maintenance of continence. The successful outcome is associated with significant improvement in quality of life.
Highlights
As simple, low anal fistulas can be treated safely only by fistulotomy, the management of complex fistulas needs to balance the outcomes of cure and continence
Oner Department of Radiology, Gazi University Medical School, Ankara, Turkey. The results of this series suggest that the hybrid seton might be a valid alternative for the treatment of high anal fistulas, eliminating the need for postoperative adjustments
Between April 2005 and September 2010, 147 consecutive patients fulfilling the above-mentioned selection criteria were treated with the hybrid seton for high anal fistulas
Summary
Low anal fistulas can be treated safely only by fistulotomy, the management of complex fistulas needs to balance the outcomes of cure and continence. There is a risk of sphincter muscle damage during fistulotomy, and this might lead to an unacceptable risk of anal incontinence (AI) of varying degrees [1,2,3]. The degree of incontinence depends on the amount of damaged muscle, preexisting sphincter damage, and scarring of the anal canal. The aim of this study was to evaluate our experience in managing high anal fistulas with a simple modification of the cutting seton
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