Anal Fistülün Tedavisinde Konvansiyonel Bir Prosedür Olarak Gevşek Seton Tekniği ve Uzun Dönem Sonuçları

Year 2019, , 67 - 71, 25.04.2019

Hasan Calis

https://doi.org/10.30565/medalanya.487261

Abstract

Amaç: Seton tekniği anal fistüllerin tedavisinde uzun süredir başarı ile kullanılmaktadır. Bu teknik literatürde fistül cerrahisinde anal inkontinansı azaltan bir yöntem olarak önerilmektedir. Bu çalışma, fistül cerrahisi için gevşek seton tekniği uygulanan hastaların uzun dönem sonuçlarını retrospektif olarak analiz etmeyi amaçlamaktadır. 

Yöntemler: Kasım 2014-Haziran 2016 tarihleri arasında gevşek seton tekniği uygulanan anorektal fistül tanılı 50 hastanın bilgileri bireysel takip formları kullanılarak retrospektif olarak incelendi. 

Bulgular: Çalışmaya 50 hasta dahil edildi. Ortalama takip süresi 21 aydı. Etyolojide 20 hastada kriptoglandüler apse, 2 hastada Crohn hastalığı bulunurken 28 hastada da idiyopatikti. Fistül traktının spontan kaybolmadığı ve internal sfinkter kas liflerinin tamamen kesilmediği 23 hastada kontrollü fistülotomi yapıldı. Diğer 27 hastada fistül traktının spontan rezolüsyonu gerçekleşmişti. Çalışmaya dahil edilen tüm hastalarda tam iyileşme sağlanırken ortalama 21 aylık takip süresinde rekürrens gelişmedi. 

Sonuç: Son yıllarda anal fistül için yeni tedavi yöntemleri ortaya çıkmıştır. Bu modaliteleri geleneksel yöntemlerle karşılaştıran birçok çalışma yapılmış ve bu çalışmaların hiçbiri konvansiyonel yöntemlere üstünlük gösterememiştir. Gevşek seton prosedürü 21 aylık uzun bir takip süresince düşük nüks ve inkontinans oranları ile anal fistül tedavisi için iyi tolere edilebilen bir tedavi modalitesidir. 

Keywords

Anal fistül, gevşek seton, inkontinans, cerrahi teknik

Loose Seton Technique as a Conventional Procedure for the Treatment of Anal Fistula and Long-Term Results

Abstract

Aim: The seton technique has long been used with success for the treatment of anal fistulas. This technique is recommended in the literature as a method which decreases anal incontinence in fistula surgery. This study aims to retrospectively analyze the long-term outcomes of anal patients on whom we performed loose seton technique for fistula surgery. 

Patients and Methods: The information of 50 patients with the diagnosis of anorectal fistula on whom loose seton technique was performed at our clinic between November 2014 and June 2016 were retrospectively reviewed by using the individual follow-up forms of each patient. 

Results: Fifty patients were included in the study. The mean follow-up time was 21 months. The etiology was crypto glandular abscess in 20 patients, Crohn's disease in 2 patients and idiopathic in 28 patients. In 23 patients without spontaneous resolution of fistula and incomplete division of internal sphincter muscle fibers underwent controlled fistulotomy. Spontaneous resolution of fistula tract had occurred in the remaining 27 patients. In all patients included in the study, complete healing was achieved and no recurrence, no total incontinans occurred during the 21-month mean follow-up period. 

Conclusion: New treatment modalities have emerged for anal fistulas in recent years. Many studies were performed comparing these modalities to the conventional methods and none of these studies showed superiority over the conventional methods. The loose seton procedure is a well-tolerated modality for the treatment of anal fistula with low recurrence and incontinence rates during a long follow-up period of 21 months. 

Keywords

Anal fistula, loose seton, incontinans, surgery technique

References

• 1. Mi chalopoulos A. Perianal fistulas. Tech Coloproctol 2010;14:15–17. PMID: 20676718
• 2. Culp CE. Use of Penrose drains to treat certain anal fistulas: a primary operative seton. Mayo Clin Proc 1984;59:613–17. PMID: 6381914
• 3. Galis-Rozen E, Tulchinsky H, Rosen A, Eldar S, Rabau M, Stepanski A, et al. LongTerm Outcome of Loose-Seton for Complex Anal Fistula: A Two-Centre Study of Patients with and without Crohn’s Disease. Colorectal Disease 2010;12: 358-62. PMID: 19220385
• 4. G Subhas, JS Bhullar, A Al-Omari, A Unawane, K Vijay. MR Pearlman. Setons in the Treatment of Anal Fistula: Review of Variations in Materials and Techniques. Dig Surg 2012;29:292–300. PMID: 22948115
• 5. Garcia Aguillar J, Belmonte C, Wong WD, Goldberg SM, Madof RD. Anal fistula surgery:factors associated with recurrence and incontinence. Dis Colon Rectum 1996;39:723-29. PMID: 8674361
• 6. Dudukgian H, Abcarian H. Why do we have so much trouble treating anal fistula. World J Gastroenterol 2011;17:3292–96. PMID: 21876616
• 7. Ritchie RD, Sackier JM, Hodde JP. Incontinence rates after cutting seton treatment for anal fistula. Colorectal Dis 2009;11:564–71. PMID: 19175623
• 8. Person B, Wexner S. Management of perianal Crohn’s disease. Current treatment options. Gastroenterology 2005;8:197–209. PMID: 15913509
• 9. Lim CH, Shin HKS, Kang WH, Park CH, Hong SM, Jeong SK, et al. The use of a staged drainage seton for the treatment of anal fistulae or fistulous abscesses. J Korean Soc Coloproctol 2012;28:309–14. PMID: 23346510
• 10. Rizzo JA, Naig AL, Johnson EK. Anorectal Abscess and Fistula-in-Ano: Evidence-Based Management. Surg Clin North Am 2010;90:45–69. PMID: 20109632
• 11. Mitalas LE, Van Wijk JJ, Gosselink MP, Doornebosch P, Zimmerman DE, Schouten WR. Seton drainage prior to transanal advancement flap repair: useful or not? Int J Colorectal Dis 2010;25:1499–1502. PMID: 20645104
• 12. Cirocchi R, Trastulli S, Morelli U, Desiderio J, Boselli C, Parisi A, et al. The treatment of anal fistulas with biologically derived products: is innovation better than conventional surgical treatment? An update. Tech Coloproctol 2012;17:259–73. Epub 2012 Dec 4. PMID: 23207714