Anal Fistula Clinical Trial
Official title:
Treatment of Complex Anal Fistula With Draining Seton With or Without Rerouting of the Fistula Track: a Randomized Controlled Trial
This randomized trial aimed to compare conventional draining seton with or without rerouting of the fistula track in treatment of complex anal fistula
Placement of seton is typically employed when the fistula track is involving more than 30% of
the external anal sphincter. However, attempts to reroute the seton and the involved fistula
track were made to preserve the external anal sphincter fibers and hasten healing of the anal
wound. Mann and Clifton first introduced a transposition technique for the management of high
anal and anorectal fistulas by re-routing the extrasphincteric portion of the track into an
intersphincteric position with immediate repair of the external sphincter and reported
successful outcomes of five patients in terms of quick healing and preserved anal continence.
The present study aimed to evaluate the outcome of draining seton with or without rerouting
of the fistula track in treatment complex high anal fistula regarding healing time,
postoperative pain, and incidence of recurrence and FI postoperatively. We hypothesized that
rerouting the seton to include the fistula track and the internal anal sphincter only,
preserving the external anal sphincter muscles, would serve to hasten healing and decrease
the incidence of recurrence and continence disturbances.
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