FİSTÜLOTOMİ VEYA SETON FONKSİYONELLİĞİ AZALTIR MI? RETROSPEKTİF KARŞILAŞTIRMA

Öz

Amaç: Anal kanal ile perianal cilt arasında oluşan anormal traktlar olan anal fistüller sıklıkla cerrahi müdahale gerektirmektedir. Çalışmamızda düşük transsfinkterik anal fistül tanısı alan hastalarda fistülotomi veya seton uygulaması sonrası preoperatif ve postoperatif ağrı ile fonksiyonel bozukluk değerlendirildi. Yöntem: Retrospektif bir kohort çalışmasıyla 1 Ocak 2022-1 Aralık 2024 tarihleri arasında Muğla Eğitim ve Araştırma Hastanesi’nde tedavi edilmiş hastalar incelendi. Önceden proktolojik cerrahi öyküsü olanlar, kompleks fistüller veya fonksiyon kaybına neden olabilecek eşlik eden hastalıkları bulunan hastalar dışlandı. Hastaların ağrı ve fonksiyonları, Visual Analog Skala (VAS) ve Dünya Sağlık Örgütü Yetiyitimi Değerlendirme Çizelgesi 2.0 (WHODAS 2.0) ile preoperatif, postoperatif 1. hafta ve 1. ayda değerlendirildi. Bulgular: Altmış iki fistülotomi, 55 seton olmak üzere toplamda 117 hasta çalışmaya dahil edildi. VAS skoru 1. haftada fistülotomi grubunda anlamlı şekilde artarken, 1. ayda ise belirgin azaldı (p<0.001). Seton grubundaysa VAS skorunda belirgin bir değişiklik olmadı (p>0.05). Postoperatif birinci haftada ve birinci ayda değerlendirilen WHODAS 2.0 toplam skoru ve alt ölçeklerinden hareket, yaşam aktiviteleri, topluma katılma fistülotomi grubunda anlamlı şekilde arttı (p<0.05). Seton grubundaysa WHODAS 2.0 skoru 1. haftada anlamlı şekilde arttı (p<0.001). Sonuç: Erken dönemde fistülotomi daha fazla ağrıya neden olsa da uzun vadede ağrı ve fonksiyon açısından daha iyi sonuçlar sağlamaktadır. Başlangıçta daha tolere edilebilir olan seton uygulaması ise kalıcı ağrı ve fonksiyon kaybı riski taşımaktadır. Cerrahi tercih yapılırken sadece anatomik iyileşme değil, hastaların yaşam kalitesi de dikkate alınmalıdır.

Anahtar Kelimeler

• Postoperatif Ağrı
• Rektal Fistül
• Yaşam Kalitesi

DOES FISTULOTOMY OR SETON REDUCE FUNCTIONALITY? A RETROSPECTIVE COMPARISON

Öz

Objective: Anal fistulas, abnormal tracts that form between the anal canal and the perianal skin, frequently require surgical intervention. In our study, we evaluated preoperative and postoperative pain and functional impairment after fistulotomy or seton placement in patients diagnosed with low transsphincteric anal fistulas. Method: A retrospective cohort study was conducted on patients treated at Muğla Training and Research Hospital between January 1, 2022, and December 1, 2024. Patients with a history of proctologic surgery, complex fistulas, or concomitant diseases that could cause functional loss were excluded. Patients' pain and function were assessed preoperatively at 1 week, and 1 month postoperatively using the Visual Analog Scale (VAS) and the World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0). Results: A total of 117 patients were included in the study: 62 fistulotomies and 55 setons. The VAS score increased significantly in the fistulotomy group at week 1 and decreased significantly at month 1 (p<0.001). There was no significant change in the VAS score in the seton group (p>0.05). The WHODAS 2.0 total score and its subscales, including mobility, activities of living, and community participation, assessed at 1 week and 1 month postoperatively, increased significantly in the fistulotomy group. (p<0.05). The WHODAS 2.0 score increased significantly in the seton group at week 1 (p<0.001). Conclusion: Although fistulotomy causes more pain in the early period, it provides better long-term results in terms of pain and function. While initially more tolerable, seton placement carries the risk of permanent pain and loss of function. When making a surgical decision, not only anatomical improvement but also patient quality of life should be considered.

Anahtar Kelimeler

• Postoperative Pain
• Rectal Fistula
• Quality of Life

Etik Beyan

Ethics committee approval was received from Muğla Sıtkı Koçman University Medicine and Health Sciences Ethics Committee (Decision date: 22.12.2021, Protocol no: 210033, Decision no: 27)

Kaynakça

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