Rubber Band Seton in the Management of Abscess-Anal Fistula

Hanley, Patrick H.

doi:10.1097/00000658-197804000-00016

Cited by 60 publications

(27 citation statements)

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“…22 After the suppuration has subsided, the rubber band is tightened with serial sutures or a hemorrhoidal ligator every 2 weeks until the rubber band Seton cuts through the muscle completely. 23 In a small series, a cutting seton was associated with low recurrence rates (0.8%) and minor incontinence (2-6%) and major incontinence of 5-10%. 24 Using a chemical seton, a seton coated with latex is impregnated with Kshara, an alkaline compound, and is introduced in the fistula tract and tightened progressively, allowing the chemical to cut through the fistula and allowing the tissue to reunite behind the cutting seton.…”

Section: Fistulotomy With Sphincterotomymentioning

confidence: 88%

“…2 Buie reported an incidence of 5% anal fistulas in those with anorectal abscess seen at the Mayo Clinic. 3 Using operating room data in Helsinki, Finland (1969-1978, the incidence of fistula was calculated to be 8.6 per 100,000 population per year (12.3% males and 5.6% females). 4 Nelson is his meta-analysis equated this with 20,000 to 25,000 fistulas treated annually in the United States.…”

Section: Incidencementioning

confidence: 99%

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Anorectal Infection: Abscess-Fistula

Abcarian

2011

Clinics in Colon and Rectal Surgery

180

133

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Anorectal abscess and fistula are among the most common diseases encountered in adults. Abscess and fistula should be considered the acute and chronic phase of the same anorectal infection. Abscesses are thought to begin as an infection in the anal glands spreading into adjacent spaces and resulting in fistulas in 40% of cases. The treatment of an anorectal abscess is early, adequate, dependent drainage. The treatment of a fistula, although surgical in all cases, is more complex due to the possibility of fecal incontinence as a result of sphincterotomy. Primary fistulotomy and cutting setons have the same incidence of fecal incontinence depending on the complexity of the fistula. So even though the aim of a surgical procedure is to cure a fistula, conservative management short of major sphincterotomy is warranted to preserve fecal incontinence. However, trading radical surgery for conservative (nonsphincter cutting) procedures such as a draining seton, fibrin sealant, anal fistula plug, endorectal advancement flap, dermal island flap, anoplasty, and LIFT (ligation of intersphincteric fistula tract) procedure all result in more recurrence/persistence requiring repeated operations in many cases. A surgeon dealing with fistulas on a regular basis must tailor various operations to the needs of the patient depending on the complexity of the fistula encountered. KEYWORDS: Fistula, abscess, anorectal infection, sphincterotomy, fecal incontinenceObjectives: At the completion of this article, the reader is expected to understand the etiology and pathogenesis of an anal abscessfistula, the classification of anal fistulas, and alternative surgical procedures.Anorectal abscess-fistula is one of our most common afflictions. Because of the close association of abscess and fistula in etiology, anatomy, pathophysiology, therapy and morbidity, it is appropriate to consider both entities as one, i.e., abscess-fistula or a fistulous abscess. It is also appropriate to consider an abscess as the acute and a fistula as the chronic state of anorectal suppuration. EPIDEMIOLOGY IncidenceMost publications on the subject reflect authors' experience from a single institution; this does not address the incidence of the disease due to lack of a proper denominator. Also, it is difficult if not impossible to accurately access the incidence of anorectal abscesses because they

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Section: Fistulotomy With Sphincterotomymentioning

confidence: 88%

Section: Incidencementioning

confidence: 99%

Anorectal Infection: Abscess-Fistula

Abcarian

2011

Clinics in Colon and Rectal Surgery

180

133

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“…There are cutting, loose, and chemical setons. A cutting seton may be preferred when not all the sphincter is involved and a drainage seton if the tract passes deep to all of the sphincteric muscles [6, 7, 8]. …”

Section: Discussionmentioning

confidence: 99%

Partial Fistulotomy and Modified Cutting Seton Procedure in the Treatment of High Extrasphincteric Perianal Fistulae

Durgun

Perek²,

Kapan³

et al. 2002

Dig Surg

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Aim: In our prospective study the method of partial distal fistulotomy and modified cutting seton for high extrasphincteric perianal fistulae is discussed. Methods: 10 patients (9 males and 1 female) with high extrasphincteric perianal fistulae were treated with partial distal fistulotomy and modified cutting seton. Four or five threads were introduced through the tract; one was tied tightly at the end of the operation, others were tightened every 10th day. While the tied thread cut the tissue, the others drained the tract. The follow-up period ranged from 3 months to 9 years. Results: None of the patients developed major fecal incontinence. 2 of the 10 patients complained of incontinence due to flatus. Conclusion: Distal fistulotomy and modified cutting seton can be used in perianal fistulae with high anal or rectal opening, because it combines the effects of both cutting and loose setons and because the postoperative results regarding continence are satisfactory.

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“…A prospective randomized trial by Ho et al [10], comparing ayurvedic cutting seton and fistulotomy for low fistula in ano, concluded that the chemical seton was more painful than conventional fistulotomy and there was no difference in time to wound healing, complications or functional outcome. Hanley [11] reported the use of a rubber-band seton in the surgical management of anterior abscess-anal fistulas and anterolateral fistulas in women with good functional results. Mentes et al [5] and Chuang-Wei et al [12] described the use of an elastic seton which was created by cutting a thin (2-3 mm) circular strip from a surgical glove, including its thicker sleeve.…”

Section: Variation In Seton Materialsmentioning

confidence: 99%

Setons in the Treatment of Anal Fistula: Review of Variations in Materials and Techniques

et al. 2012

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Aim: Anorectal fistulas have been a common surgical problem since ancient times. Age-old seton techniques are still practicedsuccessfully in the treatment of complex anal fistulas. Many variations in materials and techniques are described in the literature. The selection of a seton type and technique depends on personal preferences. Our aim was to put together all the available variations in materials and techniques for seton treatment. This comprehensive review will help the surgeon to become more familiar with the various options available with regard to materials and techniques. Methods: A review of the literature using Medline was done using the Key Words ‘anal fistula’ and ‘seton’. All articles published in English were reviewed. The articles which had variations in materials and techniques for seton treatment were studied. Results: Various aspects of variations in materials, insertion techniques, maintenance of tension, mechanisms of action, drainage techniques and changing the seton have been elaborated in detail. Conclusions: Throughout this paper we present the various available variations in setons with regard to materials, placement and maintenance techniques. This study will help clinicians in choosing a new seton variation or modifying their current method of treatment with setons.

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Rubber Band Seton in the Management of Abscess-Anal Fistula

Cited by 60 publications

References 0 publications

Anorectal Infection: Abscess-Fistula

Anorectal Infection: Abscess-Fistula

Partial Fistulotomy and Modified Cutting Seton Procedure in the Treatment of High Extrasphincteric Perianal Fistulae

Setons in the Treatment of Anal Fistula: Review of Variations in Materials and Techniques

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