Modified loose‐seton technique for the treatment of complex anal fistulas

M, George Pinedo; M, Gino Caselli; S, Gonzalo Urrejola; Niklitschek, Sergio; P, María Elena Molina; R, Felipe Bellolio; D, Álvaro Zúñiga

doi:10.1111/j.1463-1318.2010.02195.x

Cited by 17 publications

(6 citation statements)

References 17 publications

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“…A fistulectomy has been reported by many clinical studies as a sufficient surgical technique for successful management of a simple or a low transsphincteric anal fistula. When an advanced complicated transsphincteric or suprasphincteric fistula is encountered, many operative options, including the utilization of advancement flaps, application of an anal plug, the use of fibrin glue, radiofrequency ablation, intersphincteric fistula tract ligation, or application of a loose seton, may be involved [ 33 ].…”

Section: Discussionmentioning

confidence: 99%

The Impact of the Outcome of Treating a High Anal Fistula by Using a Cutting Seton and Staged Fistulotomy on Saudi Arabian Patients

Shirah

Shirah²

2018

Ann Coloproctol

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PurposeA cutting seton is used after a partial distal fistulotomy to treat patients with a high exrasphincteric fistula in ano to avoid fecal incontinence and recurrence. In Saudi Arabia, religious practices necessitate complete cleanness, which makes conditions affecting anal continence a major concern to patients affected by an anal fistula. Therefore, we aimed to evaluate the efficiency of the cutting seton in treating a high anal fistula among Saudi Arabians.MethodsBetween January 2005 and December 2014, a prospective study was done for 372 Saudi Arabian patients diagnosed as having a high anal fistula and treated with a cutting seton at Al-Ansar General Hospital, Medina, Saudi Arabia. 0-silk sutures were used. All patients underwent the same preoperative assessment, operative technique, and postoperative follow-up. Weekly, the seton was tightened in outpatient clinics.ResultsTwo hundred ninety-eight patients (80.1%) were males and 74 (19.9%) females. The duration of symptoms varied from 3–21 months. The fistula healed completely in 363 patients (97.6%); 58 patients (15.6%) reported some degree of incontinence to flatus, but none to feces. In 9 patients (2.4%) the fistula recurred.ConclusionThe utilization of the cutting seton method in the treatment of patients with a high anal fistula is highly efficient as it simultaneously drains the abscess, cuts the fistulous tract, and causes fibrosis along the tract. Treatment of a high anal fistula by using a staged fistulotomy with a cutting seton was very rewarding to Saudi Arabian patients who feared anal incontinence for religious reasons and was associated with low postoperative complication and recurrence rates.

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Section: Discussionmentioning

confidence: 99%

The Impact of the Outcome of Treating a High Anal Fistula by Using a Cutting Seton and Staged Fistulotomy on Saudi Arabian Patients

Shirah

Shirah²

2018

Ann Coloproctol

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“…Eitan et al [13] reported an incontinence rate of 5% after loose seton placement. In another study, the incontinence rate was reported to be 0%-8%, and only minor complaints were observed in 60% of the patients [4, 9]. …”

Section: Discussionmentioning

confidence: 99%

“…In the literature, the success rate after loose seton placement is between 44%-78% [4, 15]. Success rates, of course, depend on the location of the fistula, and they are reported to be 66% and 88% in the presence of anterior and posterior fistulae, respectively [15].…”

Section: Discussionmentioning

confidence: 99%

“…Because of this, various modifications have been proposed by different authors. Pinedo et al [4] in their modified loose seton procedure proposed a technique in which the internal orifice was mobilized away from the dentate line by creating a small incision in the internal anal sphincter. This modification keeps the fistula tract dry, which eventually accelerates the healing process.…”

Section: Discussionmentioning

confidence: 99%

“…In the presence of a complicated transsphincteric or suprasphincteric fistula, application of advancement flaps, an anal plug, fibrin glue, ligation of the intersphincteric fistula tract (LIFT), radiofrequency ablation, a loose seton, etc. are among the preferred treatment options [4]. The main objective in all these procedures is the treatment of the disease and the prevention of recurrences and anal incontinence.…”

Section: Introductionmentioning

confidence: 99%

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Application of Advancement Flap After Loose Seton Placement: A Modified Two-Stage Surgical Repair of a Transsphincteric Anal Fistula

et al. 2014

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PurposeA number of techniques have been described for the treatment of a transsphincteric anal fistula. In this report, we aimed to introduce a relatively new two-stage technique, application of advancement flap after loose seton placement, to present its technical aspects and to document our results.MethodsIncluded in this retrospective study were 13 patients (10 males, 3 females) with a mean age of 42 years who underwent a two-stage seton and advancement flap surgery for transsphincteric anal fistula between June 2008 and June 2013. In the first stage, a loose seton was placed in the fistula tract, and in the second stage, which was performed three months later, the internal and external orifices were closed with advancement flaps.ResultsAll the patients were discharged on the first postoperative day. The mean follow-up period was 34 months. Only one patient reported anal rigidity and intermittent pain, which was eventually resolved with conservative measures. The mean postoperative Wexner incontinence score was 1. No recurrence or complications were observed, and no further surgical intervention was required during follow-up.ConclusionThe two-stage seton and advancement flap technique is very efficient and seems to be a good alternative for the treatment of a transsphincteric anal fistula.

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The Seton in Anal Fistula Management

Martellucci

Vuolo

2021

Anal Fistula and Abscess

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Modified loose‐seton technique for the treatment of complex anal fistulas

Abstract: The technique shows excellent results in the treatment of complex anal fistulas with conservation of fecal continence.

Cited by 17 publications

References 17 publications

The Impact of the Outcome of Treating a High Anal Fistula by Using a Cutting Seton and Staged Fistulotomy on Saudi Arabian Patients

The Impact of the Outcome of Treating a High Anal Fistula by Using a Cutting Seton and Staged Fistulotomy on Saudi Arabian Patients

Application of Advancement Flap After Loose Seton Placement: A Modified Two-Stage Surgical Repair of a Transsphincteric Anal Fistula

The Seton in Anal Fistula Management

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