Perianal Fistül Cerrahisinde Seton Tekniği: İki Farklı Seton Materyalinin Klinik Sonuçları

Yıl 2021, , 287 - 295, 27.09.2021

Murat Yıldırım , Hüseyin Bakır

https://doi.org/10.21673/anadoluklin.903232

Öz

Amaç: Bu çalışmada iki farklı seton materyali kullanılarak ameliyat edilen perianal fistül (PF) hastalarında nüks, inkontinans ve tedavi başarı oranlarını karşılaştırmak amaçlanmıştır.
Yöntem: Ocak 2016—Mayıs 2020 döneminde bir tıp fakültesi hastanesinde PF tanısı alan ve seton yöntemi kullanılarak ameliyat edilen toplam 66 hastanın tıbbi verileri (fistül özellikleri, hastanede kalış ve takip süreleri, postoperatif komplikasyonlar, nüks ve inkontinans varlığı) retrospektif olarak incelendi. Hastalar, kullanılan (Prolene veya cerrahi eldivenlerden elde edilen elastik bant) seton materyaline göre iki gruba ayrıldı. İnkontinans değerlendirmesi için Jorge–Wexner inkontinans skorlama sistemi kullanıldı.
Bulgular: Hastaların 48’i (%72,7) erkek, 18’i (%27,3) kadındı. Yirmi altı hasta (%39,4) Prolene, 40 hasta (%60,6) elastik bant seton kullanılarak ameliyat edilmişti. Genel iyileşme oranı %93,9, nüks oranı %7,6, inkontinans oranı %6,1 idi. Prolene grubunda nüks ve inkontinans oranları daha yüksek olmasına rağmen iki grup arasında istatistiksel olarak anlamlı fark yoktu (sırasıyla p=0,074 ve p=0,292).
Sonuç: Cerrahi eldivenden elde edilen elastik materyal, geleneksel kesici seton materyalleri gibi düşük nüks ve kabul edilebilir inkontinans oranları ile PF cerrahisinde seton olarak kullanılabilir.

Anahtar Kelimeler

Anal fistül, Elastik seton, İnkontinans

Destekleyen Kurum

Hayır

The Seton Technique in Perianal Fistula Surgery: Clinical Outcomes of Two Different Types of Seton Material

Öz

Aim: In this study we aimed to compare the recurrence, incontinence and treatment success rates in patients with perianal fistulas (PF) who were operated on using two different seton materials.
Methods: We retrospectively reviewed the medical records (PF characteristics, length of hospital stay and follow-up, postoperative complications, and presence of recurrence and incontinence) of a total of 66 patients who were diagnosed with PF and operated on using the seton method in a medical faculty hospital between January 2016 and May 2020. The patients were divided into two groups according to the seton material used (Prolene or elastic band material obtained from surgical gloves). Incontinence assessments were made using the Jorge–Wexner incontinence scoring system.
Results: Of the patients, 48 (72.7%) were male and 18 (27.3%) were female. Prolene and elastic seton materials were used in the surgery of 26 (39.4%) and 40 (60.6%) patients, respectively. The general recovery rate was 93.9%, recurrence rate was 7.6%, and incontinence rate was 6.1%. Although the recurrence and incontinence rates were higher in the Prolene group, there was no statistically significant difference between the two groups (p=0.074 and p=0.292, respectively).
Conclusion: Elastic material obtained from surgical gloves can be used as a seton in PF surgery, with low rates of recurrence and acceptable rates of incontinence similar to those with traditional cutting seton materials.

Anahtar Kelimeler

Anal fistula, Elastic seton, Incontinence

Kaynakça

• Malik AI, Nelson RL. Surgical management of anal fistulae: a systematic review. Colorectal Dis. 2008;10(5):420–30.
• Cariati A. Fistulotomy or seton in anal fistula: a decisional algorithm. Updates Surg. 2013;65(3):201–5.
• Bleier JI, Moloo H. Current management of cryptoglandular fistula-in-ano. World J Gastroenterol. 2011;17(28):3286–91.
• Parks AG, Gordon PH, Hardcastle JD. A classification of fistula-in-ano. Br J Surg. 1976;63(1):1–12.
• Sileri P, Cadeddu F, D’Ugo S, Franceschilli L, Blanco GV, Luca E, et al. Surgery for fistula-in-ano in a specialist colorectal unit: a critical appraisal. BMC Gastroenterol. 2011;11:120.
• Leventoğlu S, Menteş BB. Anal fistula plug for treatment of complex anorectal fistula. Turk J Colorectal Dis. 2007;17:211–4.
• Akici M, Ersen O. The effect of suture selection in complex anal fistulas on the success of cutting seton placement and patient comfort. Pak J Med Sci. 2020;36(4):816–20.
• Jorge JM, Wexner SD. Etiology and management of fecal incontinence. Dis Colon Rectum. 1993;36(1):77–97.
• Memon AA, Murtaza G, Azami R, Zafar H, Chawla T, Laghari AA. Treatment of complex fistula in ano with cable-tie seton: a prospective case series. ISRN Surg. 2011;2011:636952.
• 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(3):581–6.
• Sentovic SM. Fibrin glue for anal fistulas. Dis Colon Rectum. 2003;46:498–502.
• Ellis CN, Rostas JW, Greiner FG. Long-term outcomes with the use of bioprosthetic plugs for the management of complex anal fistulas. Dis Colon Rectum. 2010;53:798–802.
• Subhas G, Bhullar JS, Al-Omari A, Unawane A, Mittal VK, Pearlman R. Setons in the treatment of anal fistula: review of variations in materials and techniques. Dig Surg. 2012;29:292–300.
• Lehmann JP, Graf W. Efficacy of LIFT for recurrent anal fistula. Colorectal Dis. 2013;15:592–5.
• Lo O, Wei R, Foo D, Law WL. Ligation of intersphincteric fistula tract procedure for the management of cryptoglandular anal fistula. Surg Pract. 2012;16:120–1.
• Tan KK, Tan IJ, Lim FS, Koh DC, Tsang CB. The anatomy of failures following the ligation of intersphincteric tract technique for anal fistula: a review of 93 patients over 4 years. Dis Colon Rectum. 2011;54:1368–72.
• Buchanan GN, Bartram CI, Phillips RK, Gould SW, Halligan S, Rockall TA, et al. Efficacy of fibrin sealant in the management of complex anal fistula: a prospective trial. Dis Colon Rectum. 2003;46:1167–74.
• Patrlj L, Kocman B, Martinac M, Jadrijevic S, Sosa T, Sebecic B, et al. Fibrin glue-antibiotic mixture in the treatment of anal fistulae: experience with 69 cases. Dig Surg. 2000;17:77–80.
• Goldberg SM, Garcia-Aguilar J. The cutting seton. In: Phillips RKS, Luniss PJ (ed.), Anal Fistula. London: Chapman & Hall Medical; 1996:95–102.
• Tyler KM, Aarons CB, Sentovich SM. Successful sphincter-sparing surgery for all anal fistulas. Dis Colon Rectum. 2007;50:1535–9.
• Takesue Y, Ohge H, Yokoyama T, Murakami Y, Imamura Y, Sueda T. Long-term results of seton drainage on complex anal fistulae in patients with Crohn’s disease. J Gastroenterol. 2002;37:912–5.
• Ratto C, Grossi U, Litta F, Di Tanna GL, Parello A, De Simone V, et al. Contemporary surgical practice in the management of anal fistula: results from an international survey. Tech Coloproctol. 2019;23(8):729–41.
• Chuang-Wei C, Chang-Chieh W, Cheng-Wen H, Tsai-Yu L, Chun-Che F, Shu-Wen J. Cutting seton for complex anal fistulas. Surgeon. 2008;6:185–8.
• Mentes BB, Oktemer S, Tezcaner T, Azili C, Leventoğlu S, Oğuz M. Elastic one-stage cutting seton for the treatment of high anal fistulas: preliminary results. Tech Coloproctol. 2004;8:159–62.
• Ege B, Leventoğlu S, Menteş BB, Yılmaz U, Öner AY. Hybrid seton for the treatment of high anal fistulas: results of 128 consecutive patients. Tech Coloproctol. 2014;18(2):187–93.
• Theerapol A, So BY, Ngoi SS. Routine use of setons for the treatment of anal fistulae. Singapore Med J. 2002;43:305–7.
• Zbar AP, Ramesh J, Beer-Gabel M, Salazar R, Pescatori M. Conventional cutting vs. internal anal sphincter-preserving seton for high trans-sphincteric fistula: a prospective randomized manometric and clinical trial. Tech Coloproctol. 2003;7(2):89–94.
• Lykke A, Steendahl J, Wille-Jørgensen PA. Høje analfistler behandlet med langsomt skaerende seton [Treating high anal fistulae with slow cutting seton]. Ugeskr Laeger. 2010;172(7):516–9.
• Garcia‐Aguilar J, Belmonte C, Wong DW, Goldberg SM, Madoff RD. Cutting seton versus two‐stage seton fistulotomy in the surgical management of high anal fistula. Br J Surg. 1998;85:243–5.
• Mylonakis E, Katsios C, Godevenos D, Nousias B, Kappas AM. Quality of life of patients after surgical treatment of anal fistula; the role of anal manometry. Colorectal Dis. 2001;3:417–21.
• Ritchie RD, Sackier JM, Hodde JP. Incontinence rates after cutting seton treatment for anal fistula. Colorectal Dis. 2009;11(6):564–71.