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11-04-2010 | Gastroenterology | Article

Loose seton most effective for Crohn’s disease anal fistula patients

Abstract

Free abstract

MedWire News: Treatment of complex anal fistula with a loose seton is effective for reducing sepsis and subsequent incontinence, particularly in patients with Crohn’s disease (CD), say researchers.

“Complex anal fistulas traverse a significant portion of the external sphincter muscle, making their treatment a surgical challenge,” say Hagit Tulchinsky (Tel Aviv Sourasky Medical Center, Israel) and co-workers.

In this study, the team retrospectively reviewed the treatment records of 77 patients who had complex anal fistula and had been treated by loose seton over a 4-year period. Of these, 17 had CD and 60 did not.

The non-CD patients had a “staged section fistulotomy” involving at least two operations, whereas the CD patients had one procedure during which a “indwelling or permanent seton” was placed. In total, the patients without CD had 107 fistula related procedures and the CD patients had 29.

Early postoperative and peri-operative complications (mainly local sepsis or bleeding) occurred in eight patients overall (five non-CD, three CD). Long-term complications were more common in non-CD than CD patients with nine as opposed to four cases.

Over a median follow-up period of 24 months, the fistula recurrence rate was 47% and 40% in the non-CD and CD patients, respectively. In addition, four non-CD and one CD patient experienced at least some fecal incontinence over the observation period.

“The high recurrence rate following the use of the two-stage seton fistulotomy technique for complex anal fistula in patients without CD indicates limited effectiveness of this approach and suggests that alternative interventions such as advancement flap repair should be considered in these patients,” conclude the authors in the journal Colorectal Diseases.

However, they add: “The ‘permanent loose seton’ technique may be considered the treatment of choice in the majority of CD patients, as it is effective in preventing local sepsis in many patients over time and is associated with a low complication rate.”

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By Helen Albert