Use of Penrose Drains To Treat Certain Anal Fistulas: A Primary Operative Seton

Culp, Clyde E.

doi:10.1016/s0025-6196(12)62413-6

Cited by 44 publications

(25 citation statements)

References 6 publications

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“…Culp [3] described the use of a thin Penrose drain ( 1 / 4 -5 / 8 in) as a primary operative seton in order to utilize its elastic properties. Traction was applied by a tie of heavy silk suture passed with a small non-cutting needle through the elastic drain to prevent slippage.…”

Section: Variation In Seton Materialsmentioning

confidence: 99%

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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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Section: Variation In Seton Materialsmentioning

confidence: 99%

“…He suggested the use of 'horsehair wrapped about a lint thread' and advanced through the fistula by means of a director made of tin. The ends of the horsehair thread were intermittently tied about the enclosed muscle until the flesh was eaten through [3]. The word seton is derived from the Latin 'seta' , meaning a bristle.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2012

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“…Table 4 shows the rates of incontinence after cutting seton treatment for each classification of fistula. 'Transsphincteric' includes transsphincteric, low and high, and [35] 13 ⁄ 21 Every second day Culp [26] 3 ⁄ 20 Patient moved seton several times daily Decanini-Terán et al [37] 0 ⁄ 42 Started 3 weeks postoperative; as patient tolerated Deshpande et al [30] 0 ⁄ 397 Every week Durgan et al [38] 2 ⁄ 10 Every 10 days Dziki and Bartos [39] 12 ⁄ 32 † Once a week Fasth et al [40] 0 ⁄ 7 Started a minimum of 3 months postoperative; 2-3 times weekly Flich Carbonell et al [41] 3 ⁄ 19 Not tighten postoperatively Gonzalez-Ruiz et al [43] 0 ⁄ 31 2-Week intervals Graf et al [44] 15 ⁄ 29 Once at 4 weeks postoperative Gurer et al [25] 0 [55] 0 ⁄ 53 Weekly Mohite et al [31] 0 ⁄ 114 New setons inserted weekly Qureshi et al [57] 2 ⁄ 4 Examined weekly; tightened if necessary Shukla et al [21] 8 ⁄ 155 Seton changed weekly Tahir [58] 5 ⁄ 9 Examined weekly; tightened as necessary Theerapol et al [59] 0 ⁄ 41 Patient to pull seton on a daily basis, one week postoperative Vatansev et al [61] 5 ⁄ 32 Tightened once in a period of 2 weeks Walfisch et al [62] 0 ⁄ 23 Once at 1 month postoperative Williams et al [63] 8 ⁄ 13 Patients followed regularly; tightened as necessary Zbar et al [22] 3 ⁄ 34 2-Week intervals Average rate 11.2% *Number of incidents of incontinence ⁄ number of patients.…”

Section: Classification Of Fistulamentioning

confidence: 99%

“…These percentages add up to more than 100% because patients can experience more than one subdivision of incontinence. Only one of the reports included incontinence of mucus [26], with a rate of 5%, all the others gave data on at least two of the remaining three types of incontinence. Of all patients in Table 5, 15% were incontinent to flatus, 22% were incontinent to liquid stool and 6% were incontinent to solid stool.…”

Section: Severity Of Incontinencementioning

confidence: 99%

“…13 ⁄ 21 Cox et al [36] 4 ⁄ 8 Culp [26] 3 ⁄ 20 Decanini-Terán et al [37] 0 ⁄ 42 Deshpande et al [30] 0 ⁄ 397 Durgan et al [38] 2 ⁄ 10 Dziki and Bartos [39] 12 ⁄ 32 † Fasth et al [40] 0 ⁄ 7 Flich Carbonell et al [41] 3 ⁄ 19 García-Aguilar et al [42] 8 ⁄ 12 Gonzalez-Ruiz et al [43] 0 ⁄ 31 Graf et al [44] 11 ⁄ 29 4 ⁄ 4 Gurer ‡ et al [25] 0 ⁄ 17 Hämäläinen and Sainio [45] 22 ⁄ 35 Hamel et al [46] 0 ⁄ 12 Hammond et al [47] 4 ⁄ 16 Hasegawa et al [48] 15 ⁄ 28 Held et al [49] 0 ⁄ 9 Ho et al [20] 3 ⁄ 46 † Isbister and Al Sanea ‡ [50] 17 ⁄ 47 † Joy and Williams [51] 5 ⁄ 10 Malouf et al [52] 1 ⁄ 3 McCourtney and Finlay [53] 3 ⁄ 16 Mentes et al [54] 4 ⁄ 20 Misra and Kapur [55] 0 ⁄ 53 Mohite et al [31] 0 ⁄ 114 Pescatori et al [56] 3 ⁄ 17 Qureshi et al [57] 2 ⁄ 4 Shukla et al [21] 8 ⁄ 155 Tahir § [58] 5 ⁄ 9 Theerapol et al [59] 0 ⁄ 41 Tocchi et al [60] 4 ⁄ 28 Vatansev et al [61] 5 ⁄ 32 Walfisch et al [62] 0 ⁄ 23 Williams et al [63] 8 ⁄ 13 Zbar et al [22] 3 ⁄ 34 Average rates (%) 15.9% 100% 10.5%…”

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Incontinence rates after cutting seton treatment for anal fistula

2009

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Objective To determine the incidence of anal incontinence after the use of cutting seton treatment for anal fistula.Method Literature searches were performed on PubMed, MEDLINE and Google Ô Scholar using the words 'cutting seton(s)', 'seton(s)' and 'anal fistula'. An analysis of the data in the collected references was performed.Results The average rate of incontinence following cutting seton use was 12%. The rate of incontinence increased as the location of the internal opening of the fistula moved more proximally. In the studies that described the types of incontinence, liquid stool was the most common followed closely by flatus incontinence. Incontinence associated with the treatment of fistulas defined as nonspecific cryptoglandular in nature was 18%.Conclusion The high incontinence rates that result from the use of cutting setons suggest that this commonly used therapy can damage the continence musculature. Other techniques that do not involve cutting the sphincter, when available, should be preferred, especially for higher fistulas.

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Seton treatment of high anal fistulae

Williams

MacLeod

Rothenberger

et al. 1991

Journal of British Surgery

248

139

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Seventy-four patients who underwent seton treatment of high anal fistulae over a 6-year period have been reviewed. Four different techniques were used: staged fistulotomy (n = 24), cutting seton (n = 13), short-term seton drainage (n = 14) and long-term seton drainage in patients with Crohn's disease (n = 23). Recurrence developed in two patients (8 per cent) undergoing two-stage fistulotomy; two patients (14 per cent) undergoing short-term drainage and nine (39 per cent) of the patients with Crohn's disease. Three patients with Crohn's disease required proctectomy for progressive perianal disease. The remaining 11 patients with Crohn's disease (48 per cent) obtained a good result. None of the patients treated with a cutting seton developed a recurrence. Minor incontinence developed in 13 patients (54 per cent) undergoing two-stage fistulotomy and seven patients (54 per cent) treated with a cutting seton. When sphincter muscle was not divided, five patients (36 per cent) undergoing short-term drainage and six patients (26 per cent) undergoing long-term drainage developed minor incontinence. High complex fistulae can be successfully treated with only minor loss of continence using different seton techniques. In high Crohn's fistulae, long-term seton drainage preserves sphincter function, but recurrence is common if the seton is removed.

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Use of Penrose Drains To Treat Certain Anal Fistulas: A Primary Operative Seton

Cited by 44 publications

References 6 publications

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

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

Incontinence rates after cutting seton treatment for anal fistula

Seton treatment of high anal fistulae

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