This study evaluates low transsphincteric anal fistula managed by serial setons and interval fistulotomy, with attention to healing without recurrence and preservation of continence. Following Institutional Review Boa...This study evaluates low transsphincteric anal fistula managed by serial setons and interval fistulotomy, with attention to healing without recurrence and preservation of continence. Following Institutional Review Board approval, consecutive anal fistula operations performed by a single surgeon from January 1, 2009 to December 31, 2013 were retrospectively reviewed using electronic medical records and telephone interviews for patients lost to follow up. Of the 71 patients, 26（37%） had low transsphincteric fistula（23 males and 3 females; mean age： 46 years）, treated at our institution by seton placement followed by interval surgical muscle cutting and subsequent seton replacement or final fistulotomy. Of the 26 patients, 22（85%） were initially referred due to previous failed treatment, with a 30.6 month mean duration of fistula prior to referral and a mean of 2.2（range： 0–6） prior anorectal surgeries. At a mean follow-up of 11.9 months, none of the 21 patients experienced recurrence or fecal incontinence. Serial seton with interval muscle-cutting sphincterotomy followed by complete fistulotomy is an effective treatment for the management of patients who are either initially seen for low transsphincteric fistula, or referred after failed anorectal surgery for that condition.展开更多
Purpose: The purpose of this study was to demonstrate loose silk seton actually acts as a slow cutting seton contrary to the idea of simply drainage. Besides, to show the effect of loose seton on patient’s incontinen...Purpose: The purpose of this study was to demonstrate loose silk seton actually acts as a slow cutting seton contrary to the idea of simply drainage. Besides, to show the effect of loose seton on patient’s incontinence is mostly proportional to the degree of division of the sphincter muscle. Design: Fifty patients with high transsphincteric fistulas were treated with loose seton technique. We measured the length of high sphincteric fistula tracts, pre- and postoperative anal sphincter pressures and incontinence scores. Results: Loose seton with heavy silk resulted in 72% percent of progressive migration of the fistula tract caudally. The more the progressive migration of the loose seton loop, the less the pressure drop in both resting and squeezing in manometric studies. This study is limited by its retrospective design in prospectively collected data and covers relatively small number of patients. Conclusion: Seton is still useful technique in high perianal fistula surgery. Defining this technique as simply “loose” seton is misnomer since it acts as a slowly cutting seton and results in progressive migration of the fistula tract caudally. The more the progressive migration of the loose seton loop, the less the pressure drop would be possible after postoperatively.展开更多
Objective: The treatment of trans-sphincteric fistulas is a surgical challenge since eradicating the fistula tract while maintaining the anal continence is vitally important. In this study we documented the outcomes o...Objective: The treatment of trans-sphincteric fistulas is a surgical challenge since eradicating the fistula tract while maintaining the anal continence is vitally important. In this study we documented the outcomes of the patients with one or more fistulas treated at the same operation with a new type of seton. Patients and Methods: The study included 78 patients with 107 high anal fistulas who were treated with seton between 2007 and 2011. Fifty seven patients had only one fistula, 13 patients had two isolated fistulas and 8 patients had three isolated fistulas. Group I was the patients with one fistula and Group II was the patients having more than one fistula. Postoperative complications, hospital stay, cutting through the sphincter and healing times and Wexner’s scores were compared between the two groups. Results: In Group I, there were 57 patients and in Group II, 21 patients were operated for 50 fistulas. No postoperative complications were observed except urinary retentions (4 patients in Group I, 3 patients in Group II). No infection on the operation site was documented in both groups, in Group I none of the patients needed extra dose of narcotic analgesic but in Group II two of the patients who had 3 fistulas were discharged on the second postoperative day because of pain on the operation site. The median for the cutting seton to cut through the sphincter was 31 days and complete healing was achieved with a median of 40 days in Group I, whereas it was 56 and 65 days respectively for Group II. There were no recurrences in our patients in both groups. Although the Wexner scores of the both groups were low, the difference between the groups was statistically significant. Conclusion: It seems to be feasible to perform seton by using a cheap, effective, easily inserted material, also in treatment of patients with more than one fistula while preserving anal continence.展开更多
文摘This study evaluates low transsphincteric anal fistula managed by serial setons and interval fistulotomy, with attention to healing without recurrence and preservation of continence. Following Institutional Review Board approval, consecutive anal fistula operations performed by a single surgeon from January 1, 2009 to December 31, 2013 were retrospectively reviewed using electronic medical records and telephone interviews for patients lost to follow up. Of the 71 patients, 26（37%） had low transsphincteric fistula（23 males and 3 females; mean age： 46 years）, treated at our institution by seton placement followed by interval surgical muscle cutting and subsequent seton replacement or final fistulotomy. Of the 26 patients, 22（85%） were initially referred due to previous failed treatment, with a 30.6 month mean duration of fistula prior to referral and a mean of 2.2（range： 0–6） prior anorectal surgeries. At a mean follow-up of 11.9 months, none of the 21 patients experienced recurrence or fecal incontinence. Serial seton with interval muscle-cutting sphincterotomy followed by complete fistulotomy is an effective treatment for the management of patients who are either initially seen for low transsphincteric fistula, or referred after failed anorectal surgery for that condition.
文摘Purpose: The purpose of this study was to demonstrate loose silk seton actually acts as a slow cutting seton contrary to the idea of simply drainage. Besides, to show the effect of loose seton on patient’s incontinence is mostly proportional to the degree of division of the sphincter muscle. Design: Fifty patients with high transsphincteric fistulas were treated with loose seton technique. We measured the length of high sphincteric fistula tracts, pre- and postoperative anal sphincter pressures and incontinence scores. Results: Loose seton with heavy silk resulted in 72% percent of progressive migration of the fistula tract caudally. The more the progressive migration of the loose seton loop, the less the pressure drop in both resting and squeezing in manometric studies. This study is limited by its retrospective design in prospectively collected data and covers relatively small number of patients. Conclusion: Seton is still useful technique in high perianal fistula surgery. Defining this technique as simply “loose” seton is misnomer since it acts as a slowly cutting seton and results in progressive migration of the fistula tract caudally. The more the progressive migration of the loose seton loop, the less the pressure drop would be possible after postoperatively.
文摘Objective: The treatment of trans-sphincteric fistulas is a surgical challenge since eradicating the fistula tract while maintaining the anal continence is vitally important. In this study we documented the outcomes of the patients with one or more fistulas treated at the same operation with a new type of seton. Patients and Methods: The study included 78 patients with 107 high anal fistulas who were treated with seton between 2007 and 2011. Fifty seven patients had only one fistula, 13 patients had two isolated fistulas and 8 patients had three isolated fistulas. Group I was the patients with one fistula and Group II was the patients having more than one fistula. Postoperative complications, hospital stay, cutting through the sphincter and healing times and Wexner’s scores were compared between the two groups. Results: In Group I, there were 57 patients and in Group II, 21 patients were operated for 50 fistulas. No postoperative complications were observed except urinary retentions (4 patients in Group I, 3 patients in Group II). No infection on the operation site was documented in both groups, in Group I none of the patients needed extra dose of narcotic analgesic but in Group II two of the patients who had 3 fistulas were discharged on the second postoperative day because of pain on the operation site. The median for the cutting seton to cut through the sphincter was 31 days and complete healing was achieved with a median of 40 days in Group I, whereas it was 56 and 65 days respectively for Group II. There were no recurrences in our patients in both groups. Although the Wexner scores of the both groups were low, the difference between the groups was statistically significant. Conclusion: It seems to be feasible to perform seton by using a cheap, effective, easily inserted material, also in treatment of patients with more than one fistula while preserving anal continence.
