Ann Coloproctol.  2018 Oct;34(5):234-240. 10.3393/ac.2018.03.23.

The Impact of the Outcome of Treating a High Anal Fistula by Using a Cutting Seton and Staged Fistulotomy on Saudi Arabian Patients

• Shirah BH
• Shirah HA

• KMID: 2427530
• DOI: http://doi.org/10.3393/ac.2018.03.23

Abstract

PURPOSE
A cutting seton is used after a partial distal fistulotomy to treat patients with a high exrasphincteric fistula in ano to avoid fecal incontinence and recurrence. In Saudi Arabia, religious practices necessitate complete cleanness, which makes conditions affecting anal continence a major concern to patients affected by an anal fistula. Therefore, we aimed to evaluate the efficiency of the cutting seton in treating a high anal fistula among Saudi Arabians.
METHODS
Between January 2005 and December 2014, a prospective study was done for 372 Saudi Arabian patients diagnosed as having a high anal fistula and treated with a cutting seton at Al-Ansar General Hospital, Medina, Saudi Arabia. 0-silk sutures were used. All patients underwent the same preoperative assessment, operative technique, and postoperative follow-up. Weekly, the seton was tightened in outpatient clinics.
RESULTS
Two hundred ninety-eight patients (80.1%) were males and 74 (19.9%) females. The duration of symptoms varied from 3-21 months. The fistula healed completely in 363 patients (97.6%); 58 patients (15.6%) reported some degree of incontinence to flatus, but none to feces. In 9 patients (2.4%) the fistula recurred.
CONCLUSION
The utilization of the cutting seton method in the treatment of patients with a high anal fistula is highly efficient as it simultaneously drains the abscess, cuts the fistulous tract, and causes fibrosis along the tract. Treatment of a high anal fistula by using a staged fistulotomy with a cutting seton was very rewarding to Saudi Arabian patients who feared anal incontinence for religious reasons and was associated with low postoperative complication and recurrence rates.

Keyword

High anal fistula; Staged fistulotomy; Cutting seton; Saudi Arabia

MeSH Terms

Abscess
Ambulatory Care Facilities
Fecal Incontinence
Feces
Female
Fibrosis
Fistula
Flatulence
Follow-Up Studies
Hospitals, General
Humans
Male
Methods
Postoperative Complications
Prospective Studies
Rectal Fistula*
Recurrence
Reward
Saudi Arabia
Sutures