Long-term follow-up study of loose combined cutting seton surgery for patients with high anal fistula

Abstract

Background: The treatment of high anal fistula (HAF) is still difficult for clinical surgeons. Our previous study demonstrated the short-term benefit of loose combined cutting seton (LCCS) for patients with HAF.This study aimed to evaluate the long-term effectiveness of LCCS for treating HAF patients.Methods: We retrospectively enrolled consecutive HAF patients who received LCCS therapy in our hospital between March 2014 and July 2017. After enrollment, all patients were followed up by clinical review. The patients' clinical information and most recent follow-up results were collected. Pain was assessed by the visual analog scale (VAS), and the severity of fecal incontinence was assessed by the Wexner Continence Grading Scale. We also assessed the patients' quality of life (QOL) using a the MOS item short from health survey (SF-36) questionnaire. HAF healing was considered the primary outcome, while the fistula recurrence rate, severity of fecal incontinence, and QOL were the secondary outcomes.Results: In total, 22 patients (18 male, four female) were enrolled in the final analysis. The mean duration of follow-up was 3.65 years (interquartile range: 3.55-4.22; range, 3.50-5.43). All patients were cured and there was no recurrence during the follow-up period. Eight patients reported a Wexner score of 1, while the remaining patients reported a score of 0 at the final follow-up. Furthermore, one patient had a VAS score of 1, while the remaining patients had a VAS score of 0, which indicated almost no postoperative pain. The QOL of all patients improved significantly.Conclusions: LCCS is an effective method to treat HAF patients. Large, multicenter randomized controlled trials are warranted.

Evaluation surgical strategies in perianal fistulas treatment: Efficacy draining seton compared to other surgical approaches; a case‐control study

“…Fistula relapse was also observed in only two patients (4.8%) 30 . According to Zhi et al, 31 22 subjects (18 males, four females) were examined for a mean of 3.65 years after receiving loosely combined cutting seton (LCCS). All patients were cured, and there were no recurrences during the follow‐up period, highlighting the effectiveness, safety, and reliability of LCCS in treating patients with high anal fistulas 31 .…”

“…According to Zhi et al, 31 22 subjects (18 males, four females) were examined for a mean of 3.65 years after receiving loosely combined cutting seton (LCCS). All patients were cured, and there were no recurrences during the follow‐up period, highlighting the effectiveness, safety, and reliability of LCCS in treating patients with high anal fistulas 31 . Omar et al 32 implemented a prospective randomized controlled trial to compare the clinical outcomes between the separate drainage seton and drainage seton combined with fistula tract rerouting (EAS‐sparing Seton after rerouting).…”

“…All patients were cured, and there were no recurrences during the follow‐up period, highlighting the effectiveness, safety, and reliability of LCCS in treating patients with high anal fistulas. 31 Omar et al 32 implemented a prospective randomized controlled trial to compare the clinical outcomes between the separate drainage seton and drainage seton combined with fistula tract rerouting (EAS‐sparing Seton after rerouting). The findings depicted no significant difference in relapse rate and complications between the two groups.…”

Evaluation of the Cutting Seton Technique in Treating High Anal Fistula

“…Furthermore, the loose seton technique can improve drainage and accelerate the stages of healing without a high risk of injury to the sphincter. Although the cutting seton can totally cure the fistula by gradually transecting the external sphincter muscle, it often results in some complications, including incontinence and even severe post-operative pain [ 6 ].…”

The use of a loose seton as a definitive surgical treatment for anorectal abscesses and complex anal fistulas

“…Short-and long-term benefits have been observed with the use of loose setons. 7 It has been reported that loose seton use is beneficial in patients with transsphincteric anal fistulas. The preservation of an anatomical loss of the external sphincter function is important with this technique.…”