Loose seton in the treatment of transsphincteric anal fistulas complicated by additional fistula tracks (randomized trial)
https://doi.org/10.33878/2073-7556-2024-23-4-94-100
Abstract
AIM: to evaluate caudal migration of free seton in patients with anal fistulas complicated by additional fistula tracks.
PATIENTS AND METHODS: the prospective randomized single-center study included 115 patients with transshincteric fistulas, who had one of 2 types of seton installed. The decision to choose a seton was made by randomization in 2 groups: 63 patients with a polyester braided ribbon with a fluoropolymer coating 3 mm wide (Polyester-F Braid 3 mm, “Balumed” LLC, Russian Federation) seton “T”, and the 2nd group included 52 patients with a seton polyester braided ribbon with a fluoropolymer coating with a diameter of 0.5 mm of USP conditional number 2 with a diameter of 0.5 mm was installed (Polyester-F Thread USP 2 with a diameter of 0.5 mm, “Balumed” LLC, Russian Federation) — seton “N”.
RESULTS: after 12 weeks the largest number of complete caudal migration occurred in 30/63 (47.6%; 95% CI: 34.9–60.6) patients with seton “T”, whereas in patients with seton “N” it occurred significantly less often in 7/52 (13.5%; 95% CI: 5.6–25.8) patients (p = 0.0002). Caudal seton migration with sphincter involvement of more than 1/2 was noted only in 1 patient with seton “T”, and was completely absent in patients with seton “N”.
CONCLUSION: in patients with a fistulas involving less than 1/2 of the external sphincter, it is reasonable to use a 3 mm wide fluoropolymer-coated polyester braided band as a seton, expecting caudal migration in almost half of the cases. Whereas the installation of a 0.5-mm diameter fluoropolymer-coated polyester braided thread, when more than 1/2 of the external sphincter is involved, does not lead to caudal migration.
About the Authors
A. G. Khitaryan
Clinical Hospital “RZD-Medicine” ; Rostov State Medical University
Russian Federation
Russian Federation
Alexander G. Khitaryan
Varfolomeeva st., 92a, Rostov-on-Don, 344011
Nakhichevan Lane, 29, Rostov-on-Don, 344022
A. Z. Alibekov
Clinical Hospital “RZD-Medicine” ; Rostov State Medical University
Russian Federation
Russian Federation
Albert Z. Alibekov
Varfolomeeva st., 92a, Rostov-on-Don, 344011
Nakhichevan Lane, 29, Rostov-on-Don, 344022
A. A. Golovina
Clinical Hospital “RZD-Medicine”
Russian Federation
Russian Federation
Anastasia A. Golovina
Varfolomeeva st., 92a, Rostov-on-Don, 344011
S. A. Adizov
Clinical Hospital “RZD-Medicine”
Russian Federation
Russian Federation
Suleiman A. Adizov
Varfolomeeva st., 92a, Rostov-on-Don, 344011
X. S. Oplimakh
Rostov State Medical University
Russian Federation
Russian Federation
Xenia S. Oplimakh
Nakhichevan Lane, 29, Rostov-on-Don, 344022
References
1. Kryvoruchko I.A., Firsyk T.M.. Modern Minimally Invasive Sphincter-Sparing Techniques of Surgical Treatment of Anal Fistulas. Novosti Khirurgii. 2020;28(5):565–576. (in Russ.). doi: 10.18484/2305-0047.2020.5.565
2. Alasari S, Kim NK. Overview of anal fistula and systematic review of ligation of the intersphincteric fistula tract (LIFT). Tech Coloproctol. 2014 Jan;18(1):13–22. doi: 10.1007/s10151-013-1050-7
3. Денисенко Э.В., Гаин Ю.М., Денисенко В.Л. Свищи прямой кишки: современное состояние проблемы. Хирургия. Восточная Европа. 2022; 11(4).
4. Musin A.I., Antipova E.V., Ulyanov A.A., et al. Ligature in the treatment of rectal fistula: a modern view of the oldest method (literature review). Bulletin of Surgery named after I.I. Grekov. 2019;178(2):79–84. (in Russ.). doi: 10.24884/0042-4625-2019-178-2-79-84
5. Adams F. The Genuine Works of Hippocrates. N.-Y.: William Woods &Company. 1939; 345–350.
6. Hanley PH. Rubber band seton in the management of abscess-anal fistula. Ann Surg. 1978;187:435–437.
7. Williams JG, Farrands PA, Williams AB, et al. The treatment of anal fistula: ACPGBI position statement. Colorectal Dis. 2007;9(4):8–50.
8. Patton V, Chen CM, Lubowski D. Long-term results of the cutting seton for high anal fistula. ANZ J Surg. 2015;85(10):720–727.
9. Ritchie RD, Sackier JM, Hodde JP. Incontinence rates after cutting seton treatment for anal fistula. Colorectal Dis. 2009;11(6):564–571.
10. Lim CH, Shin HK, Kang WH, et al. The use of a staged drainage seton for the treatment of anal fistulae or fistulous abscesse. J Korean Soc Coloproctol. 2012;28(6):309–314.
11. Emile SH, Elfeki H, Thabet W, et al. Predictive factors for recurrence of high transsphincteric anal fistula after placement of seton. Journ Of Surgical Research. 2017;213:261–268.
12. Subhas G, Gupta A, Balaraman S, et al. Non-cutting setons for progressive migration of complex fistula tracts: a new spin on an old technique. Int J Colorectal Dis. 2011;26(6):793–798.
13. Sungurtekin U, Ozban M, Erbis H, et al. Loose Seton: A Misnomer of Cutting Seton. Surgical Science. 2016;7:219–225.
14. Kelly ME, Heneghan HM, McDermott FD, et al. The role of loose seton in the management of anal fistula: a multicenter study of 200 patients. Tech Coloproctol. 2014;18(10):915–919.
15. Khitaryan A.G., Alibekov A.Z., Kovalev S.A., et al. Multistage minimally invasive treatment for perianal abscess. Koloproktologia. 2020;19(2):83–90. (In Russ.). doi: 10.33878/2073-7556-2020-19-2-83-90
Review
For citations:
Khitaryan A.G., Alibekov A.Z., Golovina A.A., Adizov S.A., Oplimakh X.S. Loose seton in the treatment of transsphincteric anal fistulas complicated by additional fistula tracks (randomized trial). Koloproktologia. 2024;23(4):94-100. https://doi.org/10.33878/2073-7556-2024-23-4-94-100
Views:
363
Email this article 
