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[Complex anal fistula treated with cutting seton]
Luis Charúa-Guindic1, Maxi Alexander Méndez-Morán, Octavio Avendaño-Espinosa
1Academia Mexicana de Cirugía, Jefe de la Universidad de Coloproctología, Servicio de Gastroenterología, Hospital General de México, Facultad de Medicina, Universidad Nacional Autónoma de México. luischarua@yahoo.com
Background:
Anorectal sepsis is a frequent condition presenting in the office of colorectal specialists. The acute phase presents as an abscess and the chronic phase as a fistula. We undertook this study to report the experience of the Coloproctology Unit of the General Hospital of Mexico in the management of complex anal fistula with cutting seton.
Methods:
From May 1999 to April 2004, 11,731 clinical cases were reviewed. Inclusion criteria were patients with complex anal fistula treated using the cutting seton technique and 6 months minimum follow-up after withdrawal of seton.
Results:
There were 742 fistulous patients among which 50 fulfilled inclusion criteria. There were 44 males and 6 females. Fistulas were classified as high transsphincteric in 41 patients, suprasphincteric in 8 patients, and high intersphincteric in one patient. On average, patients were followed-up during 9.67 postoperative examinations and on average there were 4.55 adjustments. The average permanence of seton was 7.02 months.
Conclusions:
Management of complex anal fistula continues to be a challenge for surgeons. Cutting seton is an appropriate surgical option for patients with no alteration of continence and is useful for patients with high transsphincteric, suprasphincteric and, in some cases, extrasphincteric fistula. In women with low anterior transsphincteric fistula, this option must be considered as an alternative.
