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Abstract
Background.
High anal fistulas require multiple operations and the use of sphincter sparing techniques. All these are expansive for patients living in developing countries like ours. Thus, the use of cutting seton is the main surgical method practiced here. The objective of this study was to evaluate its clinical outcomes in high anal fistula.
Patients and methods
We conducted a prospective study of patients undergoing cutting seton fistulotomy for high anal fistula. Preoperative and postoperative evaluation included anamnesis, clinical examination and anuscopy. Fecal continence was assessed using the Pescatori continence score (0 to 6).
Results
We registered 19 high transsphincteric fistulas and 1 supratrasphincteric fistula. Nine patients reported varying degrees of earlier faecal incontinence. Their mean continence score decreased from 2.8 to 2.1 (p = 0.111). It decreased from 2 to 1.5 (p = 0.495) in the diabetic patients and increased from 2.3 to 3.3 (p = 0.225) in HIV+ patients while in HIV- patients, we noted an amelioration from 1.1 to 0.6 (p = 0.049). There was no difference between pre- and postoperative values of continence in fully continent patients, although 1 patient reported minor alterations of continence (Pescatori score = 2). Healing was achieved in 17 patients with 1 case of recurrence.
Conclusion
The use of cutting seton in high anal fistula is an effective technique. It improves continence in incontinent patients and respects that of continent patients with a long lasting resolution of the problem of suppuration.
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References
- Hämätäinen K-P.J, Sainio A.P. Cutting Seton for Anal Fistulas : High Risk of Minor Control Defects. Dis Colon Rectum 1997;40(12):1443-7.
- Abcarian H. Anorectal Infection: Abscess–Fistula. Clin Colon Rectal Surg 2011;24(1):14-21.
- Rakinic J, Poola VP. Hemorrhoids and Fistulas: New Solutions for Old Problems. Current Problems in Surgery 2014;51:98-137.
- Ege B, Leventoglu S, Mentes BB¸ Yılmaz U, Öner AY. Hybrid seton for the treatment of high anal fistulas: results of 128 consecutive patients. Tech Coloproctol 2014;18(2):187-93.
- F. Pigot. Satisfaction des malades après traitement chirurgical d’une fistule anale. Le Courrier de colo-proctologie 2002;2(3):43-44.
- Abcarian H. Anorectal Infection: Abscess–Fistula. Clin Colon Rectal Surg 2011;24(1):14-21.
- Vial M, Parés D, Pera M, Grande L. Faecal incontinence after seton treatment for anal fistulae with and without surgical division of internal anal sphincter: a systematic review. Colorectal Dis 2010;12(3):172-178.
- Williams JG, Mac Leod CA, Rothenberger DA et al. Seton treatment of high fistulae. Br J Surg 1991;78(10):1159-61.
- Ritchie RD, Sackier JM, Hodde JP. Incontinence rates after cutting seton treatment for anal fistula. Colorectal Dis 2009;11(6):564-571.
- Ommer A, Herold A, Berg E, Fürst A, Sailer M, Schiedeck T. Cryptoglandular Anal Fistulas. Dtsch Arztebl Int 201;108(42):707-13.
- Pescatori M, Anastasio G, Bottini C, Mentasti A. New grading and scoring for anal incontinence. Evaluation of 335 patients. Dis Colon Rectum 1992;35(5):482-7.
- Pearl RK, Andrews JR, Orsay CP, Weisman RI, Prasad ML, Nelson RL, Cintron JR, Abcarian H, Rothenberger DA. Role of the seton in the management of anorectal fistulas. Dis Colon Rectum 1993;36(6):573-579.
- Kouadio GK, Kouadio LN, Turquin HT. Prise en charge de la Fistule anale au CHU de Treichville à Abidjan. A propos de 47 observations. Rev CAMES 2003;2:45-8.
- Zbar AP, Ramesh J, Beer-Gabel M, Salazar R, Pescatori M. Conventional cutting vs. internal anal sphincter preserving seton for high trans-sphincteric fistula : a prospective randomized manometric and clinical trial. Tech Coloproctol 2003;7(2):89-94.
- Chatterjee G, Dipankar R, Chakravartty S. Partial fistulotomy and multiple setons in high anal fistulae. Indian J Surg 2009;71(4):218-20.
- Cariati A. Fistulotomy or seton in anal fistula: a decisional algorithm. Updates Surg. 2013;65(3):201-5.
- Mentes BB, Oktemer S, Tezvaner T, Azih C, Leventogh S, Oguz M. Elastic one stage cutting seton for the treatment of high anal fistulas: preliminary results. Tech Coloproctol 2004;8(3):159-62.
- Perez F, Arroyo A, Serrano P, Candela F, Sanchez A, Calpena R. Fistulotomy with Primary Sphincter Recontruction in the Management of Complex Fistula-in-ano: Prospective Study of Clinical and Manometric Results. J Am Coll Surg 2005;200(6):897-903.
- Nadal SR, Manzione CR, Galvao VM, Salim VR, Speranzini MB. Healing after anal fistulotomy: comparative study between HIV+ and HIV- patients. Dis Colon Rectum 1998;41(2):177-9.
- Manookian CM, Sokol TP, Headrick C, Fleshner PR. Does HIV status influence the anatomy of anal fistulas? Dis Colon Rectum 1998;41(12):1529-33.
- Muñoz-Villasmil J, Sands L, Hellinger M. Management of perianal sepsis in immunosuppressed patients. Am Surg 2001;67(5):484-6.
- Schwandner O. Obesity is a negative predictor of success after surgery for complex anal fistula. BMC Gastroenterol 2011;11:61-5 Doi : 10.1186/1471-230X-11-61.
- Wang D, Yang G, Qiu J, Song Y, Wang L, Gao J, Wang C. Risk factors for anal fistula: a case-control study. Tech Coloproctol 2014;18(7):635-9.
References
Hämätäinen K-P.J, Sainio A.P. Cutting Seton for Anal Fistulas : High Risk of Minor Control Defects. Dis Colon Rectum 1997;40(12):1443-7.
Abcarian H. Anorectal Infection: Abscess–Fistula. Clin Colon Rectal Surg 2011;24(1):14-21.
Rakinic J, Poola VP. Hemorrhoids and Fistulas: New Solutions for Old Problems. Current Problems in Surgery 2014;51:98-137.
Ege B, Leventoglu S, Mentes BB¸ Yılmaz U, Öner AY. Hybrid seton for the treatment of high anal fistulas: results of 128 consecutive patients. Tech Coloproctol 2014;18(2):187-93.
F. Pigot. Satisfaction des malades après traitement chirurgical d’une fistule anale. Le Courrier de colo-proctologie 2002;2(3):43-44.
Abcarian H. Anorectal Infection: Abscess–Fistula. Clin Colon Rectal Surg 2011;24(1):14-21.
Vial M, Parés D, Pera M, Grande L. Faecal incontinence after seton treatment for anal fistulae with and without surgical division of internal anal sphincter: a systematic review. Colorectal Dis 2010;12(3):172-178.
Williams JG, Mac Leod CA, Rothenberger DA et al. Seton treatment of high fistulae. Br J Surg 1991;78(10):1159-61.
Ritchie RD, Sackier JM, Hodde JP. Incontinence rates after cutting seton treatment for anal fistula. Colorectal Dis 2009;11(6):564-571.
Ommer A, Herold A, Berg E, Fürst A, Sailer M, Schiedeck T. Cryptoglandular Anal Fistulas. Dtsch Arztebl Int 201;108(42):707-13.
Pescatori M, Anastasio G, Bottini C, Mentasti A. New grading and scoring for anal incontinence. Evaluation of 335 patients. Dis Colon Rectum 1992;35(5):482-7.
Pearl RK, Andrews JR, Orsay CP, Weisman RI, Prasad ML, Nelson RL, Cintron JR, Abcarian H, Rothenberger DA. Role of the seton in the management of anorectal fistulas. Dis Colon Rectum 1993;36(6):573-579.
Kouadio GK, Kouadio LN, Turquin HT. Prise en charge de la Fistule anale au CHU de Treichville à Abidjan. A propos de 47 observations. Rev CAMES 2003;2:45-8.
Zbar AP, Ramesh J, Beer-Gabel M, Salazar R, Pescatori M. Conventional cutting vs. internal anal sphincter preserving seton for high trans-sphincteric fistula : a prospective randomized manometric and clinical trial. Tech Coloproctol 2003;7(2):89-94.
Chatterjee G, Dipankar R, Chakravartty S. Partial fistulotomy and multiple setons in high anal fistulae. Indian J Surg 2009;71(4):218-20.
Cariati A. Fistulotomy or seton in anal fistula: a decisional algorithm. Updates Surg. 2013;65(3):201-5.
Mentes BB, Oktemer S, Tezvaner T, Azih C, Leventogh S, Oguz M. Elastic one stage cutting seton for the treatment of high anal fistulas: preliminary results. Tech Coloproctol 2004;8(3):159-62.
Perez F, Arroyo A, Serrano P, Candela F, Sanchez A, Calpena R. Fistulotomy with Primary Sphincter Recontruction in the Management of Complex Fistula-in-ano: Prospective Study of Clinical and Manometric Results. J Am Coll Surg 2005;200(6):897-903.
Nadal SR, Manzione CR, Galvao VM, Salim VR, Speranzini MB. Healing after anal fistulotomy: comparative study between HIV+ and HIV- patients. Dis Colon Rectum 1998;41(2):177-9.
Manookian CM, Sokol TP, Headrick C, Fleshner PR. Does HIV status influence the anatomy of anal fistulas? Dis Colon Rectum 1998;41(12):1529-33.
Muñoz-Villasmil J, Sands L, Hellinger M. Management of perianal sepsis in immunosuppressed patients. Am Surg 2001;67(5):484-6.
Schwandner O. Obesity is a negative predictor of success after surgery for complex anal fistula. BMC Gastroenterol 2011;11:61-5 Doi : 10.1186/1471-230X-11-61.
Wang D, Yang G, Qiu J, Song Y, Wang L, Gao J, Wang C. Risk factors for anal fistula: a case-control study. Tech Coloproctol 2014;18(7):635-9.