TREATMENT OUTCOME OF HIGH ANAL FISTULA WITH FISTULECTOMY AND SETON PLACEMENT
Main Article Content
Keywords
anal fistula, continence, fistulectomy, recurrence, Seton placement, treatment outcomes
Abstract
Background: High anal fistulas pose significant challenges in management due to their complexity and proximity to the anal sphincter. Understanding the outcomes of different treatment modalities is crucial for optimizing patient care.
Objective: This study aimed to compare the treatment outcomes of high anal fistulas using fistulectomy versus Seton placement, focusing on healing rates, recurrence, complications, and anal continence.
Study Design & Setting: This study was conducted at Alnafes Medical College And Hospital encompassing a total of 140 patients diagnosed with high anal fistulas. Participants were divided into two groups: fistulectomy (n = 70) and Seton placement (n = 70).
Methodology: Patient demographics, clinical characteristics, and treatment outcomes were reviewed. Healing rates, recurrence, complications, and fecal incontinence were assessed during a minimum follow-up period of 6 months. Statistical analysis was performed using SPSS, with p-values < 0.05 considered significant.
Results: In the fistulectomy group, 80% achieved complete healing, while the Seton group had a 71% healing rate (p = 0.14). The overall complication rate was higher in the fistulectomy group (17%) compared to the Seton group (9%) (p = 0.03). Fecal incontinence was reported in 10% of the fistulectomy group versus 4% in the Seton group (p = 0.04). The mean hospital stay and recovery time were also longer in the fistulectomy group.
Conclusion: Fistulectomy resulted in slightly better healing rates, but Seton placement offered lower complication rates and better anal continence preservation. Individualized treatment approaches are recommended based on patient-specific factors.
References
2. Kapur N, Kapur R, Varma M, Batra C, Sharma BB. Fistula in Ano—A 2-Year Prevalence Study on North Indian Rural Population. Journal of Gastrointestinal and Abdominal Radiology. 2022 Sep;5(03):140-7.
3. Srinivas Reddy K, Bali S. A Review of Various Surgical Managements and their Outcome of Fistula-in-Ano. EC Gastroenterology and Digestive System. 2020;7:54-81.
4. Fan Y, Yu Z, Xu C, Wang J, Hu T. A surgical resection of giant perianal mass secondary to complex anal fistula: a case report. Journal of Surgical Case Reports. 2024 Aug;2024(8):rjae514.
5. Warkhede S, Ghate S, Gandhi P. A study of Constipation after surgery for anorectal malformations in a tertiary hospital in Central India. European Journal of Cardiovascular Medicine. 2024 Jan 1;14(1).
6. Sarveazad A, Bahardoust M, Shamseddin J, Yousefifard M. Prevalence of anal fistulas: a systematic review and meta-analysis. Gastroenterology and Hepatology From Bed to Bench. 2022;15(1):1.
7. Kapur N, Kapur R, Varma M, Batra C, Sharma BB. Fistula in Ano—A 2-Year Prevalence Study on North Indian Rural Population. Journal of Gastrointestinal and Abdominal Radiology. 2022 Sep;5(03):140-7.
8. Ejigu N, Seyoum K, Kene C, Gomora D, Mengistu S, Geta G, Eshetu D, Tadesse S, Mesfin T, Tekalign Y, Atlaw D. Prevalence and associated risk factors for failed obstetric fistula repair in East African countries: A systematic review and meta-analysis. SAGE Open Medicine. 2023 Jul;11:20503121231187742.
9. Parwez M, Huda T, Yadav MS, Gupta K, Mital K, Pandya B. A PILOT STUDY on the Clinical and Functional Outcomes of an Improvised Technique of Core-cut Fistulectomy for Fistula-in-ano. Surgical Innovation. 2022 Jun;29(3):426-37.
10. Martellucci J, Vuolo ML. The Seton in Anal Fistula Management. Anal Fistula and Abscess. 2020:1-4.
11. Durgun C, Tüzün A. The use of a loose seton as a definitive surgical treatment for anorectal abscesses and complex anal fistulas. ADVANCES IN CLINICAL AND EXPERIMENTAL MEDICINE. 2023 Oct 1;32(10):1149-57.
12. Verkade C, van Tilborg GF, Stijns J, Wasowicz DK, Zimmerman DD. Distalization of perianal fistulas after loose silicone seton drainage is a myth. Techniques in Coloproctology. 2024 Dec;28(1):16.
13. Nahid TH, Sarkar MH, Alam MA, Imtiaz F, Haque MM, Karim MR, Rokonuzzaman M, Bithy R. Outcome of Partial Fistulotomy and Application of Modified Cutting Seton Procedure in the Treatment of Complex Fistula in Ano in a Tertiary Level Hospital. SAS J Surg. 2024 Jul;7:836-43.
14. Rezk AK. Treatment Modalities of perianal fistula. Tobacco Regulatory Science (TRS). 2023 Jan 7:7018-28.
15. Kaleem Ullah, Shams uddin, Yasin MD. Outcome of treatment of high Fistula-in-ano, with partial fistulectomy plus seton placement. Professional Med J 2021; 28(11):1600-1603.
16. 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 Disease. 2010 Mar;12(3):172-8.
17. Garcia-Aguilar J, Belmonte C, Wong DW, Goldberg SM, Madoff RD. Cutting seton versus two-stage seton fistulotomy in the surgical management of high anal fistula. British journal of surgery. 1998 Feb 1;85(2):243-5
18. Munir A, Falah SQ. Management of high fistula in ano with cutting seton. Gomal J Med Sci 2014; 12: 210-2.
19. Tyler KM, Aarons CB, Sentovich SM. Successful sphincter-sparing surgery for all anal fistulas. Diseases of the colon & rectum. 2007 Oct 1; 50(10):1535-9.
20. Loungnarath R, Dietz DW, Mutch MG, Birnbaum EH, Kodner IJ, Fleshman JW. Fibrin glue treatment of complex anal fistulas has low success rate. Diseases of the colon & rectum. 2004 Apr 1; 47(4):432-6.
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Abdul Wali Khan
MBBS, FCPS Surgery, Assistant Professor Alnafes Medical College And Hospital Islamabad, Email:
Raheel Imam Quereshi
MBBS, FCPS General Surgery Senior Registrar Department of General Surgery Al Nafees Medical College and Hospital
Monica Jan
MBBS, MS(Surgery), Assistant Professor in General Surgery Abu Umara Medical and Dental College/ Ali Fatima hospital Lahore
Khalid Ibrahim Akhtar
MBBS, FCPS, FRCS Associate professor of surgery, Department of General Surgery, HITEC Institute of Medical Sciences and HIT Hospital Taxilla
Sultan Mahmood Khan
MBBS MS (General Surgery) Associate Professor Surgery Aziz Fatima Medical College, Faisalabad
Hassan Abdullah
MBBS from AJKMC Muzaffarabad, House Officer at DHQ Sargodha