The Value of Cutting Seton for High Transsphincteric Anal Fistula in the Era of Its Misery

Abstract

Objectives: We studied the outcome of cutting seton in the treatment of a high transsphincteric anal fistula in Sudan. Methods: This was a prospective study of high transsphincteric anal fistulas at Kassala Police Hospital, Sudan, over the course of 24 months (2016–2017). The main outcomes measured were recurrence, incontinence and primary healing rates. Results: The cases of 72 patients treated with cutting seton for high transsphincteric fistula were analysed, with 50 (70%) of the patients being male and 22 (30%) being female. Forty-eight (66.7%) patients required two sessions of seton tightening with a duration of seton treatment of 30 days and 24 (33.3%) patients required three sessions with a duration of seton treatment of 45 days. Only one patient (1.4%) had flatus incontinence. Three (4.2%) patients had minimal bleeding from the seton site and two (2.8%) patients experienced fistula recurrence. Twenty-six (36%) patients achieved complete healing within 30 days, while 36 (54.3%) patients healed within 60 days. The remaining seven (9.7%) patients healed after 60 days. Chronic pain was reported by two (2.8%) patients after complete healing. Conclusion: In Sudan, cutting seton remains relevant, as it produces minimal incontinence with a low recurrence rate in high transsphincteric fistula treatment.

Effects of loose combined cutting seton surgery on wound healing and pain in patients with high anal fistula: A meta‐analysis

“…However, this approach can lead to significant postoperative pain, slow wound healing, severe anal deformity, incontinence, and other complications. 10,11 The seton technique, a traditional Chinese medical treatment, employs a thread or rubber band's constrictive force to slowly cut through the muscle encompassed by the fistula tract, thus preserving the anatomical and physiological functions of the anus. 12 Some studies have shown that, compared to simple cutting seton surgery, loose combined cutting seton surgery can effectively improve postoperative drainage and alleviate pain in patients with high anal fistulas.…”

“…Fistulectomy, a common surgical technique for high anal fistulas, involves complete exposure and excision of the tract, branches, and abscess cavity, followed by adequate drainage, effectively removing necrotic tissue and eliminating recurrence factors. However, this approach can lead to significant postoperative pain, slow wound healing, severe anal deformity, incontinence, and other complications 10,11 . The seton technique, a traditional Chinese medical treatment, employs a thread or rubber band's constrictive force to slowly cut through the muscle encompassed by the fistula tract, thus preserving the anatomical and physiological functions of the anus 12 .…”