Cutting seton versus decompression and drainage seton in the treatment of high complex anal fistula: a randomized controlled trial

Yu, Qiuxiang; Zhi, Congcong; Jia, Lansi; Li, Hui

doi:10.1038/s41598-022-11712-9

Cited by 8 publications

(4 citation statements)

References 17 publications

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“…• Fecal incontinence not to be a complication in long-term outcome with a median follow-up time of 47 months, as it was not seen in otherwise healthy infants and children in our population. Studies on adult FIA treatment confirm higher rates of fecal after cutting seton placement (13,14), which might probably also be the case after decades in discussed populations of infants with FIA and might not have been recorded in previous studies (11). • Hints to postsurgical perianal dermatitis and childhood constipation.…”

Section: Discussionmentioning

confidence: 87%

Treatment of pediatric fistula-in-ano—Sphincter-sparing non-cutting seton placement as the future treatment of choice?

et al. 2023

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BackgroundTherapeutic principles of fistula-in-ano (FIA) are lacking evidence-based consensus on treatment options. Non-cutting, sphincter-sparing options have not been published for infancy and childhood FIA.Patients and methodsWe are presenting retrospective data on FIA treatment with non-cutting seton placement between 2011 and 2020. Data were collected based on medical records and complemented by patients’ contact for follow-up analyses between November 2021 and October 2022. Data were analyzed regarding the outcome variables of recurrent FIA and recurrent perianal abscess. Furthermore, outcomes in different age groups were compared (<1/1.5–12 years of age).ResultsTreatment duration with non-cutting seton was at a median of 4.6 months and was not associated with recurrent FIA (p = 0.8893). Overall recurrence rate of FIA within an observation time of 9 months postsurgically was at 7% (n = 3/42) and was only seen in infancy, whereas recurrent perianal abscess was mainly observable in children (n = 2, p = 0.2132). Comparison of age groups revealed no significant differences. Of the 42 included patients, 37 responded in the follow-up analysis, resulting in a response rate of 88% with a median follow-up time of 4.9 years. Fecal incontinence was postsurgically only seen in two patients, who were diagnosed prior to surgery and symptoms remained unchanged.ConclusionsNon-cutting seton placement might be a promising option in the treatment of FIA in infancy and childhood. Perioperative settings like duration of placed seton and antibiotic treatment have to be discussed in further prospective, enlarged population-based studies.

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Section: Discussionmentioning

confidence: 87%

Treatment of pediatric fistula-in-ano—Sphincter-sparing non-cutting seton placement as the future treatment of choice?

et al. 2023

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“…This situation can be explained by the tension caused by the seton and the foreign body reaction. When we look at the literature, it is seen that the pain levels of the conventional drainage seton are higher than even the cutting seton [3,11]. However, no study comparing it with stulotomy has been found.…”

Section: Discussionmentioning

confidence: 99%

“…Fistulotomy is still the most successful method for treating simple stulas. However, in complex stulas, cutting seton application, drainage seton placement followed by advanced surgical methods such as video-assisted anal stula treatment (VAAFT), and ligation of the intersphincteric stula tract (LIFT) may be preferred [3,4]. In all surgical methods used, postoperative pain and loss of function are inevitable.…”

Section: Introductionmentioning

confidence: 99%

Comparison of Postoperative Pain and Functionality in Patients Undergoing Fistulotomy and Seton for Anal Fistula

ŞAHİN,

Demirci,

Yazkan

et al. 2023

Preprint

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Introduction: Anal fistula is a common proctological disease characterized by a tunnel formation between the skin and the anal canal. Surgical intervention is often required for treatment. The study aimed to assess postoperative pain and functionality in patients undergoing either fistulotomy or seton application for anal fistula. Method: The study included patients undergoing fistulotomy or seton application. Pain and functionality were assessed using the WHODAS 2.0 and VAS scores before surgery and at 1 week and 1 month post-surgery. Data were analyzed using statistical methods. Results: Out of 144 patients, 125 were included in the study. Fistulotomy was performed in 54.4% of patients, while seton application was performed in 45.6%. Pain levels were significantly higher in the fistulotomy group at postoperative 1 week but significantly lower at postoperative 1 month compared to the seton group. WHODAS 2.0 results correlated with VAS scores, showing that pain affected functionality. Seton group patients experienced less pain in the first postoperative week, but pain increased in the first month due to the presence of setons. Loss of function in social life and human relations was higher in the seton group. Discussion: Anal fistulas are more prevalent in men, but this study found a higher ratio of women, possibly due to geographical differences or the small sample size. Pain levels and functionality were affected by the choice of surgical method. Fistulotomy patients experienced increased pain in the first week but improved over time, while seton patients had lower initial pain but more persistent discomfort. Setons can disrupt daily life and social activities. Surgeons should consider long-term pain and functionality when choosing between procedures.

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“…However, due to severe pain, high incontinence rates, and patient dissatisfaction, surgeons have been looking for sphincter-sparing, more minimally invasive techniques. Recently, techniques such as laser applications to the anal fistula tract, ligation of intersphincteric fistula tract (LIFT), use of an anal fistula occlusive material, and video-assisted electrocautery of anal fistula (video-assisted anal fistula treatment, or VAAFT) have been used to preserve sphincter function in the treatment of anal fistula [ 9 ].…”

Section: Introductionmentioning

confidence: 99%

A Comparison of Laser and Fistulotomy Techniques in the Treatment of Fistula-in-Ano

Tümer¹,

Bulbuloglu²

2023

Cureus

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BackgroundAnal fistulas are a common complication of perianal abscesses. The treatment of anal fistulas is challenging, with persistent and high recurrence rates. The aim of this study was to evaluate the efficacy and costeffectiveness of laser ablation compared to fistulotomy in the treatment of anal fistulas. Materials and methodsThe patients were examined for external and internal openings of the fistula, its number, length, type, relationship with the sphincters, and any previous history of abscess or proctological surgery. The surgical procedures, complications, incontinence, recurrence, and recovery time were evaluated and compared between the two groups. The laser ablation group received an intermittent laser application at a wavelength of 1470 nm and 10 watts for three seconds, while the fistulotomy group underwent cutting of the fistula tract with electrocautery while keeping a stylet in place. ResultsA total of 253 patients were included in this retrospective study, with 149 patients undergoing fistulotomy and 104 patients undergoing laser ablation. The patients were evaluated based on the type, number, and location of internal and external openings, and the length of the fistula tract according to the Parks classification. The mean follow-up period was 9.0±4.3 months. The results showed that the laser group had a shorter time to return to work and less postoperative pain compared to the fistulotomy group. However, the recurrence rate was higher in the laser group. The recurrence rate was also found to be higher in patients with low transsphincteric fistulas and in patients with diabetes mellitus. ConclusionOur study findings indicate that while laser ablation may be associated with less pain and quicker recovery time, it may also have a higher recurrence rate compared to fistulotomy. We believe that laser ablation is a valuable option for surgeons to consider early on in the treatment process, especially in cases where fistulotomy is not suitable.

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Cutting seton versus decompression and drainage seton in the treatment of high complex anal fistula: a randomized controlled trial

Cited by 8 publications

References 17 publications

Treatment of pediatric fistula-in-ano—Sphincter-sparing non-cutting seton placement as the future treatment of choice?

Treatment of pediatric fistula-in-ano—Sphincter-sparing non-cutting seton placement as the future treatment of choice?

Comparison of Postoperative Pain and Functionality in Patients Undergoing Fistulotomy and Seton for Anal Fistula

A Comparison of Laser and Fistulotomy Techniques in the Treatment of Fistula-in-Ano

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