T M Hammond1, C H Knowles, T Porrett, P J Lunniss. 1. Centre for Academic Surgery, Institute of Cellular and Molecular Science, The Royal London Hospital, Barts, London, UK.
Abstract
OBJECTIVE: To assess the short and intermediate outcomes of a modification of the traditional cutting seton technique, using a 'snug' silastic seton, to treat idiopathic anal fistulae. PATIENTS AND METHODS: Between August 1997 and December 2002, 35 patients with idiopathic fistulae (4 female; age 26-76 years) underwent insertion of a 'snugly' tied 1 mm silastic seton (silicone nerve vessel retractor, Medasil), as definitive treatment. Short-term assessment was performed by case note review. Patients were subsequently invited to participate in a medium-term review. RESULTS: Twenty-nine patients' notes (3 female) were available for short-term analysis. Fistulae were classified as intersphincteric (9) and transsphincteric (20). The seton spontaneously cut out in 15/29 (52%) after a median of 24 weeks. In 14 patients the seton enclosed residual tissue (< 5 mm) required division as a day case procedure, at a median of 35 weeks. All fistulae healed but 10/29 (34%) patients (1 female; 8 transsphincteric) experienced minor incontinence. Sixteen patients participated in a medium-term review at a median of 42 months; 7 had experienced early continence disturbance. No patient suffered recurrence, but minor incontinence persisted in 4/16 (25%) patients (0 females; 3 transsphincteric). All patients were at least 'satisfied' with the outcome. CONCLUSION: In the short and medium term, the 'snug' seton is a safe and effective addition to the fistula surgeon's armamentarium.
OBJECTIVE: To assess the short and intermediate outcomes of a modification of the traditional cutting seton technique, using a 'snug' silastic seton, to treat idiopathic anal fistulae. PATIENTS AND METHODS: Between August 1997 and December 2002, 35 patients with idiopathic fistulae (4 female; age 26-76 years) underwent insertion of a 'snugly' tied 1 mm silastic seton (silicone nerve vessel retractor, Medasil), as definitive treatment. Short-term assessment was performed by case note review. Patients were subsequently invited to participate in a medium-term review. RESULTS: Twenty-nine patients' notes (3 female) were available for short-term analysis. Fistulae were classified as intersphincteric (9) and transsphincteric (20). The seton spontaneously cut out in 15/29 (52%) after a median of 24 weeks. In 14 patients the seton enclosed residual tissue (< 5 mm) required division as a day case procedure, at a median of 35 weeks. All fistulae healed but 10/29 (34%) patients (1 female; 8 transsphincteric) experienced minor incontinence. Sixteen patients participated in a medium-term review at a median of 42 months; 7 had experienced early continence disturbance. No patient suffered recurrence, but minor incontinence persisted in 4/16 (25%) patients (0 females; 3 transsphincteric). All patients were at least 'satisfied' with the outcome. CONCLUSION: In the short and medium term, the 'snug' seton is a safe and effective addition to the fistula surgeon's armamentarium.
Authors: F J Pérez Lara; A Moreno Serrano; J Ulecia Moreno; J Hernández Carmona; M Ferrer Marquez; L Romero Pérez; A del Rey Moreno; H Oliva Muñoz Journal: J Gastrointest Surg Date: 2014-11-25 Impact factor: 3.452
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