Seton drainage in sphincter-sparing treatment of rectal fistulas

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Sphincter-sparing procedures for rectal fistulas are becoming more popular among coloproctologists. However, the outcomes are not optimal that forces surgeons to seek new approaches in order to improve results. Seton drainage prior to radical stage is one of these methods. The effect of seton drainage on the outcomes is reviewed in the article. Elibrary, Pubmed and Google Scholar databases were analyzed. We have assessed 14 out of 151 trials for the period 1984 — 2017. There were no significant advantages of seton drainage compared with single-stage approach (χ2 = 3.84, p> 0.05, RR = 0.95, CI 95% 0.84 — 1.08). The same situation is observed for mucomuscular flap bringing down to close internal fistula. Fistula healing was more common after seton drainage deployment within 4 — 8 weeks. Bringing down of the flap to anal canal should be preferred after drainage due to less incidence of recurrences. Further trials are necessary to determine advisability of seton drainage and optimal surgical approach.

Keywords:

ligature method

seton drainage

seton

Authors:

Musin A.I.

Pirogov Russian National Research Medical University of Healthcare Ministry of the Russian Federation, Chair of Hospital-Based Surgery No. 1 of the Faculty of Medicine, Moscow, Russia

Kostarev I.V.

Gosudarstvennyĭ nauchnyĭ tsentr koloproktologii Minzdrava RF, Moskva

List of references:

Aboulian A, Kaji AH, Kumar RR. Early result of ligation of the intersphincteric fistula tract for fistula-in-ano. Dis Colon Rectum. 2011;54:289-292. https://doi.org/10.1007/dcr.0b013e318203495d
Adams F. The Genuine Works of Hippocrates. New York: William Woods & Company; 1939.
Bleier JI, Moloo H, Goldberg SM. Ligation of the intersphincteric fistula tract: an effective new technique for complex fistulas. Dis Colon Rectum. 2010;53:43-46. https://doi.org/10.1007/dcr.0b013e3181bb869f
Campbell ML, Abboud EC, Dolberg ME, Sanchez JE, Marcet JE, Rasheid SH. Treatment of refractory perianal fistulas with ligation of the intersphincteric fistula tract: preliminary results. Am Surg. 2013;79:723-727.
Chen HJ, Sun GD, Zhu P, Zhou ZL, Chen YG, Yang BL. Effective and long-term outcome following ligation of the intersphincteric fistula tract (LIFT) for transsphincteric fistula. Int J Colorectal Dis. 2017;32(4):583-585. https://doi.org/10.1007/s00384-016-2723-2
Dudukgian H, Abcarian H. Why do we have so much trouble treating anal fistula? World J Gastroenterol. 2011;17(28):3292-3296. https://doi.org/10.3748/wjg.v17.i28.3292
Ertem M, Gok H, Ozveri E, Ozben V. Application of advancement flap after loose seton placement: a modified two-stage surgical repair of a transsphincteric anal fistula. Ann Coloproctol. 2014;30(4):192-196. https://doi.org/10.3393/ac.2014.30.4.192
Hong KD, Kang S, Kalaskar S, Wexner SD. Ligation of intersphincteric fistula tract (LIFT) to treat anal fistula: systematic review and meta-analysis. Tech Coloproctol. 2014;18(8):685-691. https://doi.org/10.1007/s10151-014-1183-3
Jarrar A, Church J. Advancement flap repair: a good option for complex anorectal fistulas. Dis Colon Rectum. 2011;54(12):1537-1541. https://doi.org/10.1097/dcr.0b013e31822d7ddd
Kelly ME, Heneghan HM, McDermott FD, Nason GJ, Freeman C, Martin ST, Winter DC. The role of loose seton in the management of anal fistula: a multicenter study of 200 patients. Tech Coloproctol. 2014;18(10):915-919. https://doi.org/10.1007/s10151-014-1186-0
Lim CH, Shin HK, Kang WH, Park CH, Hong SM, Jeong SK, Kim JY, Yang HK. The use of a staged drainage seton for the treatment of anal fistulae or fistulous abscesses. J Korean Soc Coloproctol. 2012;28(6):309-314. https://doi.org/10.3393/jksc.2012.28.6.309
Liu WY, Aboulian A, Kaji AH, Kumar RR. Long-term results of ligation of intersphincteric fistula tract (LIFT) for fistula-in-ano. Dis Colon Rectum. 2013;56:343-347. https://doi.org/10.1097/dcr.0b013e318278164c
Mitalas LE, van Wijk JJ, Gosselink MP, Doornebosch P, Zimmerman DD, Schouten WR. Seton drainage prior to transanal advancement flap repair: useful or not? Int J Colorectal Dis. 2010;25(12):1499-1502. https://doi.org/10.1007/s00384-010-0993-7
Mushaya C, Bartlett L, Schulze B, Ho YH. Ligation of intersphincteric fistula tract compared with advancement flap for complex anorectal fistulas requiring initial seton drainage. Am J Surg. 2012;204(3):283-289. https://doi.org/10.1016/j.amjsurg.2011.10.025
Ooi K, Skinner I, Croxford M, Faragher I, McLaughlin S. Managing fistula-in-ano with ligation of the intersphincteric fistula tract procedure: the Western hospital experience. Colorectal Dis. 2012;14:599-603. https://doi.org/10.1111/j.1463-1318.2011.02723.x
Ommer A, Herold A, Berg E, Fürst A, Sailer M, Schiedeck T. German S3 guideline: anal abscess. Int J Colorectal Dis. 2012;27:831-837. https://doi.org/10.1007/s00384-012-1430-x
Ritchie RD, Sackier JM, Hodde JP. Incontinence rates after cutting seton treatment for anal fistula. Colorectal Dis. 2009;11(6):564-571. https://doi.org/10.1111/j.1463-1318.2008.01713.x
Rojanasakul A, Pattanaarun J, Sahakitrungruang C, Tantiphlachiva K. Total anal sphincter saving technique for fistula-in- ano; the ligation of intersphincteric fistula tract. J Med Assoc Thai. 2007;90:581-586.
Schulze B, Ho YH. Management of complex anorectal fistulas with seton drainage plus partial fistulotomy and subsequent ligation of intersphincteric fistula tract (LIFT). Tech Coloproctol. 2015;19(2):89-95. https://doi.org/10.1007/s10151-014-1245-6
Sileri P, Giarratano G, Franceschilli L, Limura E, Perrone F, Stazi A, Toscana C, Gaspari AL. Ligation of the intersphincteric fistula tract (LIFT): a minimally invasive procedure for complex anal fistula: two-year results of a prospective multicentric study. Surg Innov. 2014;21(5):476-480. https://doi.org/10.1177/1553350613508018
Sirikurnpiboon S, Awapittaya B, Jivapaisarnpong P. Ligation of intersphincteric fistula tract and its modification: results from treatment of complex fistula. World J Gastrointest Surg. 2013;5:123-128. https://doi.org/10.4240/wjgs.v5.i4.123
Sonoda T, Hull T, Piedmonte MR, Fazio VW. Outcomes of primary repair of anorectal and rectovaginal fistulas using the endorectal advancement flap. Dis Colon Rectum. 2002;45(12):1622-1628. https://doi.org/10.1007/s10350-004-7249-y
Subhas G, Gupta A, Balaraman S, Mittal VK, Pearlman R. 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. https://doi.org/10.1007/s00384-011-1189-5
Sungurtekin U, Ozban M, Erbis H, Birsen O. Loose Seton: A Misnomer of Cutting Seton. Surgical Science. 2016;7:219-225. https://doi.org/10.4236/ss.2016.75030
Tan KK, Liu X, Tsang CB, Koh DC. Identification of the internal anal opening and seton placement improves the outcome of deep postanal space abscess. Colorectal Dis. 2013;15(5):598-601. https://doi.org/10.1111/codi.12076
Tan KK, Alsuwaigh R, Tan AM, Tan IJ, Liu X, Koh DC, Tsang CB. To LIFT or to flap? Which surgery to perform following seton insertion for high anal fistula? Dis Colon Rectum. 2012;55(12):1273-1277. https://doi.org/10.1097/dcr.0b013e31826dbff0
The Surgisis AFP anal fistula plug: report of a consensus conference. Colorectal Dis. 2008;10(1):17-20.
Van Onkelen RS, Gosselink MP, Thijsse S, Schouten WR. Predictors of outcome after transanal advancement flap repair for high transsphincteric fistulas. Dis Colon Rectum. 2014;57(8):1007-1011. https://doi.org/10.1097/dcr.0000000000000154
Wallin UG, Mellgren AF, Madoff RD, Goldberg SM. Does ligation of the intersphincteric fistula tract raise the bar in fistula surgery? Dis Colon Rectum. 2012;55(11):1173-1178. https://doi.org/10.1097/dcr.0b013e318266edf3
Williams JG, Farrands PA, Williams AB, Taylor BA, Lunniss PJ, Sagar PM, Varma JS, George BD. The treatment of anal fistula: ACPGBI position statement. Colorectal Dis. 2007;9(suppl 4):18-50. https://doi.org/10.1111/j.1463-1318.2007.01372.x
Zimmerman DD, Delemarre JB, Gosselink MP, Hop WC, Briel JW, Schouten WR. Smoking affects the outcome of transanal mucosal advancement flap repair of trans-sphincteric fistulas. Br J Surg. 2003;90(3):351-354. https://doi.org/10.1002/bjs.4044

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