Outcomes of Secondary Fistulotomy Performed After Primary Fistulotomy or Loose Seton According to Operating Room and Outpatient Conditions

Abstract

Objectives: Perianal fistula has a significant impact on the patient’s quality of life, causing many problems ranging from pain and hygienic problems to sepsis. The primary aim of the present study is to compare the results of primary fistulotomy with fistulotomy following the loose seton technique. The secondary aim is to determine whether these surgical methods are affected by the operating room or polyclinic conditions in terms of disease course and complication rates. Materials and Methods: A total of 382 patients who underwent surgery were retrospectively analyzed. Uncomplicated low intersphincteric and transsphincteric fistulas are included and high complex fistulas were excluded. Results: Two hundred and twenty-eight patients underwent only fistulotomy, whereas 154 underwent fistulotomy following the partial healing process after loose seton. The recurrence significantly increases in horseshoes shaped fistulas (p=0.01). In univariate Cox proportional hazard regression analysis, length of fistula tract is proportional with the recurrence rate (p=0.005). In multivariate Cox proportional hazard regression models, transsphincteric fistula is an independent risk factor for recurrence (p=0.006). The recurrence rate was significantly higher in transsphincteric fistulas than in intersphincteric fistulas among patients who underwent fistulotomy (p<0.001). It was determined that neither the type of surgical technique nor the operation performed in the operating room or outpatient clinic conditions made a significant difference in terms of disease course and complication rates (p>0.05). Conclusion: Transsphincteric fistula is a risk factor for recurrence independent of the surgical technique. However, after a certain period of time following loose seton, secondary fistulotomy into the fistula channel reduces the recurrence rate. In addition, no significant difference was observed in terms of the course of the disease and recurrence after secondary fistulotomy whether it is performed in operating room or outpatient clinic conditions.

Keywords

• Perianal Fistula
• Seton Technique
• Fistulotomy

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