Using Thick Loose Seton Reduces the Incontinence and Enhances Healing Rate of High Type Fistula in Ano, a Retrospective Study
Journal of Surgery
Volume 4, Issue 4, August 2016, Pages: 85-88
Received: Jul. 6, 2016;
Accepted: Jul. 13, 2016;
Published: Jul. 28, 2016
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Alaa Al Wadees FRCS, Department of General Surgery, Faculty of Medicine, Jabir Ibn Hayyan Medical University, Njaf, Iraq
The recurrence of fistula in ano after operation is distressing for the patients. The aim of this study is to minimize the recurrence of fistula in ano after surgery and to protect from postoperative incontinence. 126 patients were presented to the clinic as a primary or a recurrent high fistula in ano. Only two cases of them were emergency. Fistulas due to malignancy, inflammatory bowel disease or tuberculosis were excluded. Thick loose silk suture was applied for 6 months. Healing rate was 91.26% after first operation, and 82% after second operation. No reported incontince. Application of thick seton is associated with low recurrence rate and no fecal incontinence.
Alaa Al Wadees FRCS,
Using Thick Loose Seton Reduces the Incontinence and Enhances Healing Rate of High Type Fistula in Ano, a Retrospective Study, Journal of Surgery.
Vol. 4, No. 4,
2016, pp. 85-88.
Bollard RC, Gardiner A, Lindow S, Phillips K, Duthie GS. Normal female anal sphincter: difficulties in interpretation explained. Dis. Colon Rectum 2002; 45: 171–5.
Godlewski G, Prudhomme M. Embryology and anatomy of the anorectum. Basis of Surgery Surg. Clin. North Am. 2000; 80: 319–43.
Fritsch H, Brenner E, Lienemann A, Ludwikowski B. Anal sphincter complex: reinterpreted morphology and its clinical relevance. Dis. Colon Rectum 2002; 45: 188–94.
Kaiser AM, Ortega AE. Anorectal anatomy. Surg. Clin. North Am. 2002; 82: 1125–38.
Vasilevsky CA, Gordon PH. Benign Anorectal: Abscess and Fistula. In: Wolff BG, Fleshman JW, Beck DE, Pemberton JH, Wexner SD, editors. The ASCRS Textbook of Colon and Rectal Surgery. New York: Springer, 2007: 192-214.
Kim T, Chae G, Chung SS, Sands DR, Speranza JR, Weiss EG, Nogueras JJ, Wexner SD. Faecal incontinence in male patients. Colorectal Dis 2008; 10: 124-130.
Parks AG, Gordon PH, Hardcastle JD. A classification of fistulain-ano. Br. J. Surg. 1976; 63: 1–12.
Bennett RC. A review of the results of orthodox treatment for anal fistulae. Proc. Royal Soc. Med. 1962; 55: 756–7.
Adams D, Kovalcik PJ. Fistula in ano. Surg. Gynecol. Obstet. 1981; 153: 731–2.
Sainio P, Husa A. Fistula-in-ano. Clinical features and long-term results of surgery in 199 adults. Acta Chirurgica Scand. 1985; 151: 169–76.
Parks AG, Stitz RW. The treatment of high fistula-in-ano. Dis. Colon Rectum 1976; 19: 487–99.
Kuijpers HC. Diagnosis and treatment of fistula-in-ano. Neth. J. Surg. 1982; 34: 147–52.
Mazier WP. The treatment and care of anal fistulas: a study of 1,000 patients. Dis. Colon Rectum 1971; 14: 134–44.
McElwain JW, McLean MD, Alexander RM. Anorectal problems. Experience with primary fistulectomy for anorectal abscess. Report 1000 cases. Dis. Colon Rectum 1975; 18: 646–9.
Miller GV, Finan PJ. Flap advancement and core fistulectomy for complex rectal fistula. Br. J. Surg. 1998; 85: 108–10.
Hyman N. Endoanal advancement flap repair for complex anorectal fistulas: how I do it. Am. J. Surg. 1999; 178: 337–40.
Lee CL, Lu J, Lim TZ, Koh FH, Lieske B, Cheong WK, Tan KK. Long-term outcome following advancement flaps for high anal fistulas in an Asian population: a single institution's experience. Int J Colorectal Dis. 2015; 30 (3): 409-12.
Schouten WR, Zimmermann DDE, Briel JW. Transanal advancement flap repair o transsphincteric fistulas. Dis. Colon Rectum 1999; 42: 1419–22.
Cronkite ET, Lozner EL, Deaver JM. Use of thrombin and fibrinogen in skin grafting. J. Am. Med. Assoc. 1944; 124: 976–8.
Hjortrup A, Moesgaard FA, Kjaergard J. Fibrin adhesive in the treatment of perianal fistulas. Dis. Colon Rectum 1991; 34: 752–4.
Aitola P, Hiltunen KM, Matikainen M. Fibrin glue in perianal fistulas – a pilot study. Ann. Chir. Gynaecol. 1999; 88: 136–8.
Venkatesh KS, Ramanujam PS. Fibrin glue application in the treatment of recurrent anorectal fistulas. Dis. Colon Rectum 1999; 42: 1136–9.
Lunniss PJ, Thomson JP. The loose seton. In: Phillips, RK, Lunniss, PJ, eds. Anal Fistula. London: Chapman & Hall, 1996.
Ramanujam PS, Prasad ML, Abcarian H. The role of the seton in fistulotomy of the anus. Surg. Gynaecol. Obstet. 1983; 157: 419–22.
Shawki S; Wexner SD. Idiopathic fistula in ano. World J Gastroenterol 2011 July 28; 17 (28): 3277-3285.
Sushruta Samhita; Chikitsasthana. Chapter 1, Shlokas 29-33; 5thed. (Motilal Banarasi Das, Varanasi, India), 1975, p 456.
Shukla NK, Narang R, Nair NGK. Multicentric randomized controlled clinical trial of Kshaarasootra (Ayurvedic medicated thread) in the management of fistula-in-ano. Indian J. Med. Res. 1991; 94: 177–85
Pearl RK, Andrews JR, Orsay CP, et al. Role of the seton in the management of anorectal fistulas. Dis Colon Rectum. 1993 Jun; 36 (6): 573-7.
Rapini, Ronald P.; Bolognia, et al. (2007). Dermatology: 2-Volume Set. St. Louis: Mosby. p. 1443.
Ritchie RD, Sackier JM, Hodde JP. Incontinence rates after cutting seton treatment for anal fistula. Colorectal Dis. 2009 Jul; 11 (6): 564-71.
Fung AK, Card GV, Ross NP, et al. Operative strategy for fistula in ano without division of the anal sphincter. Ann R Coll Surg Engl 2013; 95: 461-467.
Subhas G, Bhullar JS, Omari A, et al. Setons in the treatment of anal fistula: review of variations in materials and techniques. Dig Surg 2012; 29: 292–300.
Akiba RT1, Rodrigues FG1, da Silva G1. Management of Complex Perineal Fistula Disease. Clin Colon Rectal Surg. 2016 Jun; 29 (2): 92-100. doi: 10.1055/s-0036-1580631.
Cadeddu F1, Salis F, Lisi G, Ciangola I, Milito G. Complex anal fistula remains a challenge for colorectal surgeon. Int J Colorectal Dis. 2015 May; 30 (5): 595-603.