ABSTRACT
Objective To compare the clinical efficacy and safety of second -stage and one -stage extra-dissection and loose seton operation in the treatment of complex anal fistula complicated with abscess . Methods From May 2015 to December 2016 ,100 patients with complex anal fistula complicated with abscess were chosen in the First People's Hospital of Wuyi County .The patients were randomly divided into two groups , with 50 patients in each group .The control group received second -stage extra-dissection and loose seton operation ,and the observation group received one -stage extra-dissection and loose seton operation .The clinical effects ,operation time,wound healing time , hospital stay and the incidence of complications after operation of the two groups were compared.Results The total effective rates of the control group and the observation group were 94.00％,96.00％, respectively,there was no statistically significant difference between the two groups (χ2 =8.78,P >0.05).The operation time,wound healing time and hospital stay of the observation group were shorter than those of the control group,and the differences were statistically significant (t=3.72,2.96,3.40,all P<0.05).The incidence rates of urinary retention,bleeding and wound infection after operation of the control group were 2.00％,4.00％,6.00％, respectively,which of the observation group were 4.00％,2.00％,8.00％,respectively,there were no statistically significant differences between the two groups (χ2 =1.04,0.79,1.13,all P>0.05).Conclusion Second-stage and one-stage extra-dissection and loose seton operation in the treatment of complex anal fistula complicated with abscess has the same clinical effects and safety;but one -stage extra -dissection and loose seton operation can efficiently shorten the operation time and speed up the postoperative rehabilitation .
ABSTRACT
To explore the therapeutic effect of micro-traumatic surgery of loose seton and cutting seton by rubber bands in the treatment of high anorectal fistulae.Application of cutting seton (truss rubber bands) implemented the high part of fistulae and loose seton (ligation rubber band but non-fastened) for the low part of fistulae.133/136 patients undergoing micro-traumatic surgery were cured by one operation,2 cases had pseudo-healing and there was 1 recurrent case.And the curative rate was 97.8％.The microtraumatic surgery of loose seton and cutting seton by rubber bands in the treatment of high anorectal fistula has such multiple advantages as small incision,minor trauma,lesser pain,faster healing and a shorter course of treatment.And it may preserve the proper anal function and the integrity of anal skin.And its clinical efficacy is satisfactory.
ABSTRACT
PURPOSE: The cutting seton technique is a world-wide operative method in management of a complex anal fistula. However it has still some risks of anal deformity and fecal incontinence because of sphincter injury, and also required two-stage operation under the anesthesia. We have modified this conventional method into sphincter-preserving technique using the seton and evaluated the clinical effect of patients with complex anal fistula. METHODS: The operative steps consisted of excision of the fistular tract without cutting the sphincter, and insertion of a non-absorbable suture material as a seton around the sphincter. When enough fibro-granulated tissues grew and pus discharge decreased markedly, the seton was just cut out from the wound without anesthesia at the outpatient basis. The clinical effect following treatment by using this method was assessed retrospectively in 81 patients, including 33 recurrent cases, who were treated during the four and a half-year period. RESULTS: The average follow-up period to remove the seton and to eradicate the fistula was 68.9+/-39.5 and 82.1+/-45.6 days, respectively. No patients experienced fecal incontinence after surgery. The fistula was healed without recurrence in 78 patients (96.3%), preserving integrity of the sphincter. Recurrence developed in 3 patients who had two suprasphincteric fistulas and one transsphincteric fistula with supralevator abscess. CONCLUSION: We suggest that this method is good for treating complex anal fistulas without two-stage operation because it has some advantages such as a lower recurrence, a lower functional impairment, and less anal deformity.