Abstract
ObjectivesWe studied the outcome of cutting seton in the treatment of a high transsphincteric anal fistula in Sudan.MethodsThis was a prospective study of high transsphincteric anal fistulas at Kassala Police Hospital, Sudan, over the course of 24 months (2016–2017). The main outcomes measured were recurrence, incontinence and primary healing rates.ResultsThe cases of 72 patients treated with cutting seton for high transsphincteric fistula were analysed, with 50 (70%) of the patients being male and 22 (30%) being female. Forty-eight (66.7%) patients required two sessions of seton tightening with a duration of seton treatment of 30 days and 24 (33.3%) patients required three sessions with a duration of seton treatment of 45 days. Only one patient (1.4%) had flatus incontinence. Three (4.2%) patients had minimal bleeding from the seton site and two (2.8%) patients experienced fistula recurrence. Twenty-six (36%) patients achieved complete healing within 30 days, while 36 (54.3%) patients healed within 60 days. The remaining seven (9.7%) patients healed after 60 days. Chronic pain was reported by two (2.8%) patients after complete healing.ConclusionIn Sudan, cutting seton remains relevant, as it produces minimal incontinence with a low recurrence rate in high transsphincteric fistula treatment.
Highlights
A fistula is an abnormal epithelised communication between two epithelial surfaces
We evaluated the outcomes of cutting seton for the treatment of high transsphincteric anal fistulas over the course of 12 months at Kassala Police Hospital
The high transsphincteric fistula was described as a fistula that passes at the mid-anal canal and traverses across the middle or upper external anal sphincter
Summary
An anal fistula or fistula-in-ano connects the anorectum to the perineal skin. Fistula-in-ano is one of the most common surgical problems, with an incidence rate of up to 2.8 per 10,000 [1]. Such conditions usually affect men more than women and those affected are most often in their fifth decade of life [2–5]. A high transsphincteric anal fistula has been defined as a fistula tract passing through the upper or middle third of the external anal sphincter or mid-anal canal [6, 7]. Cutting seton is a suture knot that is placed in the fistulous track around the anal sphincter that is tied with tension and tightened intervally until the track is completely superficialised or cut through. Cutting seton has been associated with high faecal incontinence with a reported rate of 25%
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