title: Hybrid seton for the treatment of high anal fistulas: results of 128 consecutive patients.
abstract: BACKGROUND
  The aim of this study was to evaluate our experience in managing high anal fistulas with a simple modification of the cutting seton.
  
  
  METHODS
  We performed a retrospective review of standardized patient charts and of prospectively collected scores and questionnaires. Surgical outcomes of 128 consecutive, well-documented patients with high anal fistulas, including anterior transsphincteric fistulas in females, treated using a hybrid seton, were analyzed.
  
  
  RESULTS
  No significant complications occurred. The mean postoperative pain scores on a visual analog scale were 3.23 and 0.61, on days 1 and 7, respectively. Complete healing was achieved in 67 cases (52.3 %) at 1 month and in all cases (100 %) at 3 months. Recurrent fistula was noted in 2 patients (1.5 %) at 6 and 12 months. The mean postoperative incontinence scores at 3 and 12 months did not differ significantly from the preoperative score (p = 0.061, Wilcoxon's test). The depression, life style, and embarrassment item scores of the fecal incontinence quality of life index improved significantly after surgical treatment.
  
  
  CONCLUSIONS
  The results of this series suggest that the hybrid seton might be a valid alternative for the treatment of high anal fistulas, eliminating the need for postoperative adjustments. The slow and stable cutting of the sphincter seems to have a positive effect on the maintenance of continence. The successful outcome is associated with significant improvement in quality of life.
authors: Department of Surgery, Private Koru Hospital, Ankara, Turkey.
authors: B
authors: B
authors: Ege
authors: S
authors: S
authors: Leventoğlu
authors: B B
authors: BB
authors: Menteş
authors: U
authors: U
authors: Yılmaz
authors: A Y
authors: AY
authors: Öner
mesh_terms: D000328:Adult; D000368:Aged; D017577:Cutaneous Fistula / Q000150:complications / Q000601:surgery*; D003863:Depression / Q000523:psychology; D005242:Fecal Incontinence / Q000209:etiology / Q000523:psychology*; D005260:Female; D006801:Humans; D008019:Life Style; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D010149:Postoperative Pain / Q000209:etiology; D011788:Quality of Life / Q000523:psychology; D012003:Rectal Fistula / Q000150:complications / Q000601:surgery*; D012008:Recurrence; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013536:Suture Techniques; D055815:Young Adult
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