Definitive seton management for transsphincteric fistula‐in‐ano: harm or charm?

Rosen, David R.; Kaiser, Andreas M.

doi:10.1111/codi.13120

Cited by 32 publications

(22 citation statements)

References 46 publications

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“…They reported a healing time of 3.6 weeks which was lower than that analysed in our study probably due to inclusion of both low and high anal fistulas in the former study. Rosen et al 17 reported a healing time of 3 months which was comparably long probably due to increased intervals between progressive tightening of the seton wire (1 month) compared to 1 week in our study.…”

Section: Table 3 Comparison Of Pain Between the Two Groupssupporting

confidence: 44%

Outcomes of Lift Versus Seton in Complex Fistula-in-Ano- A Comparative Study

Gupta¹,

Sharma²,

Singla³

et al. 2018

jebmh

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BACKGROUNDA fistula-in-ano is an abnormal tract or cavity establishing a communication between rectum or anal canal and the perianal area. Surgery is the treatment of choice with the goals of draining infection, eradicating the fistulous tract and avoiding persistent or recurrent disease while preserving anal sphincter function. Various surgical options available include fistulotomy/fistulectomy with seton wire placement, advanced flaps, fistula plugs, fibrin glue and more recently newer techniques such as Ligation of the intersphincteric fistula tract (LIFT), Video-assisted anal fistula treatment (VAAFT) and FILAC technique (Fistula-Tract Laser Closure).The present study was conducted to assess and compare the outcome of LIFT procedure and Seton wire placement in complex fistula-in-ano.

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Section: Table 3 Comparison Of Pain Between the Two Groupssupporting

confidence: 44%

Outcomes of Lift Versus Seton in Complex Fistula-in-Ano- A Comparative Study

Gupta¹,

Sharma²,

Singla³

et al. 2018

jebmh

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“…Anecdotal comparison of ultrasound appearances of the sphincters after cutting seton suggest less sphincter separation than after fistulotomy, but it is uncertain if like is being compared with like [116]. Rosen and Kaiser [117] used data from Ritchie et al [118] to demonstrate an association between the rate of incontinence and the interval between seton tightening, which they interpreted as supporting evidence that slow sphincter division preserves sphincter function. However, this requires a large leap of faith, as the data used were very heterogeneous, with different definitions of incontinence and periods of follow-up.…”

Section: Recommendationsmentioning

confidence: 99%

“…However, follow‐up was short and postoperative assessment of continence was limited. Rosen and Kaiser reported on 121 patients with a transsphincteric fistula treated by tight seton. Initial healing occurred in 90% of patients, rising to 98% after further surgical procedures.…”

Section: Treatmentmentioning

confidence: 99%

The treatment of anal fistula: secondACPGBIPosition Statement – 2018

Williams

Tozer

et al. 2018

Colorectal Disease

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“…Hippocrates was the first to use this technique where he inserted horsehair with lint in the fistula tract and then periodically tightened it. It is used almost for all types of anal fistulae and is showing a high healing rate between 80-100% 19,20 . However there is a lot of controversy regarding this type of operation and generally, nowadays it is not anymore recommended for anal fistula treatment because of a relevant incontinence rate in some studies with numbers fluctuating between 0-63% 10,21,22 .…”

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confidence: 99%

Longterm outcome of anal fistula – A retrospective study

Andreou

Zeindler

Oertli

et al. 2020

Sci Rep

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This retrospective observational study analyses the outcomes of patients undergoing surgery for anal fistula at a single centre in order to assess recurrence and re-operation rates after different surgical techniques. During January 2005 and May 2013, all patients with anal fistula were included. Baseline characteristics, details of presentation, fistula anatomy, type of surgery, post-surgical outcomes and follow-up data were collected. The primary endpoints were long-term closure rate and recurrence rate after 2 years. Secondary endpoints were persistent pain, postoperative complications and continence status. A total of 65 patients were included. From a total amount of 93 operations, 65 were fistulotomies, 13 mucosal advancement flaps, 7 anal fistula plugs and 8 cutting-setons. The mean follow up was 80 months. Healing was achieved in 85%. The highest recurrence rate was seen in anal fistula plug with 42%. On the other hand, no recurrence was observed in the cutting-seton procedures. For all included operation no persistent postoperative pain nor incontinence was observed. In conclusion, despite all existing anal fistula operations up to date, the optimal technique with low recurrence rate and assured safety for the anal sphincter is still lacking. Nonetheless, according to our promising results for the cutting-seton technique, this technique, otherwise considered obsolete, should be further evaluated in a prospective study.

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Definitive seton management for transsphincteric fistula‐in‐ano: harm or charm?

Cited by 32 publications

References 46 publications

Outcomes of Lift Versus Seton in Complex Fistula-in-Ano- A Comparative Study

Outcomes of Lift Versus Seton in Complex Fistula-in-Ano- A Comparative Study

The treatment of anal fistula: secondACPGBIPosition Statement – 2018

Longterm outcome of anal fistula – A retrospective study

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