Application of the Hybrid Seton Technique in High, Complex Perianal Fistulas and One-Year Outcomes

Abstract

Introduction: Perianal fistulas are defined as abnormal, epithelialized connections in the anorectal region. In this study, we aimed to present the treatment outcomes of patients undergoing treatment with an elastic cutting seton (hybrid seton) for tran ssphincteric fistulas. Materials and Methods: A total of 92 cases diagnosed with high and complex anal fistulas in our hospital's general surgery clinic between 2023-2024 were included in the study. Patients had fistulas involving more than one -third of the sphincter muscles or transsphincteric fistulas in the anterior region. Demographic data, operation duration, treatment plans, visual analog scores , anal incontinence scores, recurrence rates, and complications were evaluated. Results: All patients presented with complaints of malodorous discharge, pain, swelling, and pruritus ani in the perianal region. During examination under anesthesia, the fistula tract was identified with a stylet, and the wrist portion of a size 8 glove was pla ced as a seton. The seton either fell off spontaneously or was removed with a fistulotomy within an average of 45 days. Over an average 12 -month follow-up period, no recurrence or incontinence was observed in any of the cases. Conclusıon: The hybrid seton technique does not cause incontinence as it gradually cuts through sphincter tissue without causing acute damage. Additionally, the lack of seton revisions and quality-of-life deterioration in follow-up makes hybrid seton a preferred treatment option.