Evaluation of the Cutting Seton Technique in Treating High Anal Fistula

Abstract

Objectives Fistula-in-ano is a common condition that negatively affects the quality of life of its sufferers. A high anal fistula poses a significant challenge for surgeons due to its proximity to the anorectal ring and the potential risk of incontinence rather than recurrence. Many modalities have been used in a justified search for a satisfactory cure for the condition, but the seton remains a mainstay of surgical treatment. Therefore, the rationale of this study is to assess the outcome of treating a high anal fistula using the cutting seton technique in a hospital in Al Madinah, Saudi Arabia. The evaluation is intended through a retrospective analysis of patients' outcomes, comparing its effectiveness to similar articles. Methods This is a retrospective study that includes 50 patients with high anal fistulas who were treated with a cutting seton at the National Guard Hospital over a four-year period (2019-2022). Information obtained from medical records included clinical and demographic data. The data collected during the study was compiled and statistically analyzed using the SPSS Statistics version 26.0 (IBM Corp. Released 2019. IBM SPSS Statistics for Windows, Version 26.0. Armonk, NY: IBM Corp.). A p-value of <0.05 was considered statistically significant. Results A total of 50 patients with high anal fistula treated with a cutting seton were included: 82% were males and 18% were females, with 66% below 45 years of age. Approximately 92% had inter-sphincteric fistulas, and only 28% had a recurrent fistula. Almost all patients (98%) had an MRI done before surgery. Around 70% of patients were completely cured, 26% had minor complications, 8% of the operated patients experienced mild incontinence, and only one recurrence (2%). Conclusion The cutting seton is still a valid modality in treating patients with a high anal fistula, as it is considerably safe, effective, and yields good outcomes. Standard preoperative assessment and thorough surgical techniques are cornerstones for achieving a satisfactory outcome.

Evaluation surgical strategies in perianal fistulas treatment: Efficacy draining seton compared to other surgical approaches; a case‐control study

“…Despite developing different surgical techniques to treat perianal fistulas, it is still a major medical issue. Recently, some novel treatment methods for managing perianal fistula have been proposed, which rely on the surgeon's skills, experience, and the complexity of the fistula, all of which contribute to the success of these procedures 23 . Despite this, studies have revealed that they have disadvantages compared with traditional treatments, along with being less cost‐effective 24 .…”

“…Despite this, studies have revealed that they have disadvantages compared with traditional treatments, along with being less cost‐effective 24 . However, these various techniques can be employed to treat high fistulas, cutting setons still playing an important role 23 . A seton drainage procedure may be the best option in cases of multiple previous surgeries, compared to other procedures, which are potentially challenging and complicate the patient's current situation.…”