Share This Article:

Can More than One Fistula Be Treated by a New Type of Seton Concomitantly?

Abstract Full-Text HTML XML Download Download as PDF (Size:1835KB) PP. 35-38
DOI: 10.4236/ss.2013.41006    4,095 Downloads   5,802 Views  

ABSTRACT

Objective: The treatment of trans-sphincteric fistulas is a surgical challenge since eradicating the fistula tract while maintaining the anal continence is vitally important. In this study we documented the outcomes of the patients with one or more fistulas treated at the same operation with a new type of seton. Patients and Methods: The study included 78 patients with 107 high anal fistulas who were treated with seton between 2007 and 2011. Fifty seven patients had only one fistula, 13 patients had two isolated fistulas and 8 patients had three isolated fistulas. Group I was the patients with one fistula and Group II was the patients having more than one fistula. Postoperative complications, hospital stay, cutting through the sphincter and healing times and Wexner’s scores were compared between the two groups. Results: In Group I, there were 57 patients and in Group II, 21 patients were operated for 50 fistulas. No postoperative complications were observed except urinary retentions (4 patients in Group I, 3 patients in Group II). No infection on the operation site was documented in both groups, in Group I none of the patients needed extra dose of narcotic analgesic but in Group II two of the patients who had 3 fistulas were discharged on the second postoperative day because of pain on the operation site. The median for the cutting seton to cut through the sphincter was 31 days and complete healing was achieved with a median of 40 days in Group I, whereas it was 56 and 65 days respectively for Group II. There were no recurrences in our patients in both groups. Although the Wexner scores of the both groups were low, the difference between the groups was statistically significant. Conclusion: It seems to be feasible to perform seton by using a cheap, effective, easily inserted material, also in treatment of patients with more than one fistula while preserving anal continence.

Conflicts of Interest

The authors declare no conflicts of interest.

Cite this paper

Erenoğlu, B. , Arslan, K. , Köksal, H. and Doğru, O. (2013) Can More than One Fistula Be Treated by a New Type of Seton Concomitantly?. Surgical Science, 4, 35-38. doi: 10.4236/ss.2013.41006.

References

[1] K. M. B. Dunn and D. A. Rothenberger, “Colon, Rectum and Anus. Schwartz’s Principles of Surgery,” 9th Edition, McGraw-Hill Companies, Inc., New York, 2010.
[2] C. Vatansev, O. Alabaz, A. Tekin, F. Aksoy, H. Yilmaz, T. Kucukkartallar, T. Akcam and A. Pamukcu, “A New Seton Type for the Treatment of Anal Fistula,” Digestive Diseases and Sciences, Vol. 52, No. 8, 2007, pp. 1920-1923. doi:10.1007/s10620-007-9793-5
[3] A. Michalopoulos, V. Papadopoulos, N. Tziris and S. Apostolidis, “Perianal Fistulas,” Techniques in Coloproctology, Vol. 1, Suppl. 1, 2010, pp. S15-S17. doi:10.1007/s10151-010-0607-y
[4] G. N. Buchanan, H. A. Owen, J. Torkington, et al., “Long Term Outcome Following Loose-Seton Technique for External Sphincter Preservation in Complex Anal Fistulae,” British Journal of Surgery, Vol. 91, No. 4, 2004, pp. 476-480. doi:10.1002/bjs.4466
[5] A. Theerapol, B. Y. J. So and S. S. Ngoi, “Routine Use of Setons for the Treatment of Anal Fistulae,” Singapore Medical Journal, Vol. 43, No. 6, 2002, pp. 305-307.
[6] G. N. Buchanan, C. I. Bartram, R. K. Phillips, et al., “Efficacy of Fibrin Sealant in the Management of Complex Anal Fistula: A Prospective Trial,” Diseases of the Colon & Rectum, Vol. 46, No. 9, 2003, pp. 1167-1174. doi:10.1007/s10350-004-6708-9
[7] A. Eitan, M. Koliada and A. Bickel, “The Use of the Loose Seton Technique as a Definitive Treatment for Recurrent and Persistent High Trans-Sphincteric Anal Fistulas: A Long Term Outcome,” Journal of Gastrointestinal Surgery, Vol. 13, No. 6, 2009, pp. 1116-1119. doi:10.1007/s11605-009-0826-6
[8] R. A. White, T. E. Eisenstat, R. J. Rubin and E. P. Salvati, “Seton Management of Complex Anorectal Fistulas in Patients with Crohn’s Disease,” Diseases of the Colon & Rectum, Vol. 33, No. 7, 1990, pp. 578-579. doi:10.1007/BF02052212
[9] R. K. Pearl, J. R. Andrews, C. P. Orsay, R. I. Weisman, M. L. Prasad, R. L. Nelson, J. R. Cintron and H. Abcarian, “Role of the Seton in the Management of Anorectal Fistulas,” Diseases of the Colon & Rectum, Vol. 36, No. 6, 1993, pp. 573-577. doi:10.1007/BF02049864
[10] W. H. Isbister and A. Sanea, “The Cutting Seton: An Experience at King Faisal Specialist Hospital,” Diseases of the Colon & Rectum, Vol. 44, No. 5, 2001, pp. 722-727. doi:10.1007/BF02234574
[11] W. F. Van Tets and J. H. C. Kuijpers, “Seton Treatment of Perianal Fistula with High Anal or Rectal Opening,” British Journal of Surgery, Vol. 82, No. 7, 1995, pp. 895-897. doi:10.1002/bjs.1800820711
[12] J. M. Jorge and S. D. Wexner, “Etiology and Management of Fecal Incontinence,” Diseases of the Colon & Rectum, Vol. 36, No. 1, 1993, pp. 77-97. doi:10.1007/BF02050307

  
comments powered by Disqus

Copyright © 2020 by authors and Scientific Research Publishing Inc.

Creative Commons License

This work and the related PDF file are licensed under a Creative Commons Attribution 4.0 International License.