The effect of suture selection in complex anal fistulas on the success of cutting seton placement and patient comfort.

Murat Akıcı,Ogün Erşen

doi:10.12669/pjms.36.4.1920

Abstract

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.

Highlights

Anal fistula is a surgical condition which can be defined as chronic abnormal communication between the epithelialised surface of the anal canal and the perianal skin
The perianal fistulas were divided into four groups such as intersphincteric, transsphincteric, suprasphincteric, and extrasphincteric fistulas based on the distance between the tract and anal sphincter
The study consisted of 90 patients who underwent a tight-cutting seton placement following the diagnosis of complex anal fistula

Summary

Introduction

Anal fistula is a surgical condition which can be defined as chronic abnormal communication between the epithelialised surface of the anal canal and the perianal skin. The prevalence is 2-fold higher in men than in women.[3] antibiotherapy provides relief in symptoms at the beginning of the disease, the definitive treatment is surgery.[4] In 1976, Parks et al.[5] published a groundbreaking classification of anal fistulas with the aim to determine which surgical modality should be preferred. In this classification, the perianal fistulas were divided into four groups such as intersphincteric, transsphincteric, suprasphincteric, and extrasphincteric fistulas based on the distance between the tract and anal sphincter. There are studies in the literature which define fistulas as “simple” or “complex”

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Discussion

Conclusion