The Effects of Modified Fistulotomy with Seton in Complex or Recurred Fistula-in-ano

초록

Purpose: Internal sphincterectomy and insertion of a seton is world-wide use operative method in management of a complex or recurred fistula-in-ano. But still it has some risk of anal deformity and fecal incontinence, and is also required two-stage operation under the general or regional anesthesia. We modify this traditional operative method that remove the seton without cut the internal sphincter, only. We evaluated the clinical effects of patients with complex or recurred fistula-in-ano by our modified method. Method: The operative steps consisted of excision of the fistular tract without cut the sphincter muscle, and insertion of a non-absorbable suture material as a seton around the sphincter. After enough granulation tissues are grown around the wound and pus discharge is decreased, the seton is just cutting out from the wound without anesthesia on the outpatient base. In this way, we have accomplished successful results without any anal deformity and fecal incontinence. Clinical effects following treatment with this method was assessed retrospectivly in 96 patients(56 complex and 40 recurred) who were treated during a four and half-year period. Results: The fistula was healed without recurrence in 95 patients(99.0%), preserving integrity of the sphincter muscle. And no patients experienced fecal incontinence at the time of discharge from outpatient review. Recurrence developed in 1 patient. The average follow up period to remove the seton was 68.9 days. On the one hand, the average period between the day of operation and the day of complete cure was 82.5 days. In complex and recurred cases, the periods were 126.2 and 73.7 days, respectively. Conclusions: Although this method is needed relatively long period to cure, we are concluded that this method is good and furthermore it has some advantages such as a lower recurrence, a lower functional impairment, and less anal deformity.