Abstract
Background
The aim of the present study was to document our recent experience in managing horseshoe fistula of cryptoglandular origin with a modification of the Hanley procedure using a hybrid elastic one-stage cutting seton.
Methods
Surgical outcomes of the modified Hanley procedure for horseshoe fistulae using a seton from 2004 through 2010 were analyzed. The seton fashioned from a surgical glove was tied around the sphincter under less tension than a traditional cutting seton, hence the definition of “hybrid seton”. In addition to excision of the superficial segments of the lateral tracts, deeper extensions into the ischiorectal spaces were curetted, and Penrose drains were placed.
Results
All of the patients were discharged on the first postoperative day. None required readmission or needed narcotic analgesics after discharge. Complete healing was achieved in all 21 cases at 8.0 ± 3.22 weeks postoperatively. Patients were able to return to regular work activity in 3.5 ± 1 weeks. The postoperative Cleveland Clinic Incontinence Score did not differ significantly from the preoperative score (p = 0.317, Wilcoxon’s test). Recurrent fistula was noted in a single patient (4.8 %) after a mean follow-up of 20.9-months.
Conclusions
The use of the hybrid elastic seton is a useful and safe additional modification for the treatment of horseshoe fistulae with the Hanley technique.
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References
İnceoğlu R, Gençosmanoğlu R (2003) Fistulotomy and drainage of deep postanal space abscess in the treatment of posterior horseshoe fistula. BMC Surgery 3:10
Rosen SA, Colquhoun P, Efron J et al (2006) Horseshoe abscesses and fistulas: how are we doing? Surg Innov 13:17–21
Read DR, Abcarian H (1979) A prospective survey of 474 patients with anorectal abscess. Dis Colon Rectum 22:566–568
Pritchard TJ, Schoetz DJ, Robets PL, Murray JJ, Coller JA, Veidenheimer MC (1990) Perirectal abscess in Crohn’s disease: drainage and outcome. Dis Colon Rectum 33:933–937
Sangwan YP, Schoetz DJ, Murray JJ, Roberts PL, Coller JA (1996) Perianal Crohn’s disease: results of local surgical management. Dis Colon Rectum 9:529–535
Browder LK, Sweet S, Kaiser AM (2009) Modified Hanley procedure for management of complex horseshoe fistulae. Tech Coloproctol 13:301–306
Wilhelm A (2011) New technique for anal fistula repair using a novel radial emitting laser probe (FILAC™). Tech Coloproctol 15:445–449
Meinero P, Mori L (2011) Video-assisted anal fistula treatment (VAAFT): a novel sphincter-saving procedure for treating complex anal fistulas. Tech Coloproctol 15:417–422
Hanley PH (1965) Conservative surgical correction of horseshoe abscess and fistula. Dis Colon Rectum 85:364–368
Hanley PH, Ray JE, Pennington EE, Grablowsky OM (1976) Fistula-in-ano: a ten-year follow-up study of horseshoe-abscess fi a te-in-ano. Dis Colon Rectum 19:507–515
Garcia-Aguilar J, Belmonte C, Wong DW, Goldberg SM, Madoff RD (1996) Anal fistula surgery. Factors associated with recurrence and incontinence. Dis Colon Rectum 39:723–729
Thomson JP, Ross AH (1998) Can the external anal sphincter be preserved in the treatment of transsphincteric fistula in ano? Int J Colorect Dis 4:247–250
Nelson H, Dozois RR (2001) Anus. In: Townsend CN et al. (eds) Sabiston Textbook of Surgery: The biological basis of modern surgical practice. Saunders WB, Philadelphia, pp. 974–996
Held D, Khubchandani I, Sheets J, Stasik J, Rosen L, Riether R (1986) Management of anorectal horseshoe abscess and fistula. Dis Colon Rectum 29:793–797
Ustynoski K, Rosen L, Stasik J, Riether R, Sheets J, Khubchandani IT (1990) Horseshoe abscess fistula: seton treatment. Dis Colon Rectum 33:602–605
Williams JG, MacLeod CA, Rothenberger DA, Goldberg SM (1991) Seton treatment of high anal fistulae. Br J Surg 78:1159–1161
Pezim ME (1994) Successful treatment of horseshoe fistula requires deroofing of deep postanal space. Am J Surg 67:513–515
Panidis S, Papadopoulos VN, Michalopoulos A et al (2010) The use of fibrin glue in the treatment of complex perianal fistulae: a case report. Tech Coloproctol 1:S19–S20
Damin DC, Rosito MA, Contu PC, Tarta C (2009) Fibrin glue in the management of complex anal fistula. Arq Gastroenterol 46:300–303
Yeung JM, Simpson JA, Tang SW, Armitage NC, Maxwell-Armstrong C (2010) Fibrin glue for the treatment of fistulae in ano–a method worth sticking to? Colorectal Dis 12:363–366
Koehler A, Risse-Schaaf A, Athanasiadis S (2004) Treatment of horseshoe fistulas-in-ano with primary closure of the internal fistula opening: a clinical and manometric study. Dis Colon Rectum 47:1874–1882
Garcia-Aguilar J, Belmonte C, Wong DW, Goldberg SM, Madoff RM (1998) Cutting seton versus two-stage seton fistulotomy in the surgical man- agement of high anal fistula. Br J Surg 85:243–245
Pearl RK, Andrews JR, Orsay CP et al (1993) Role of the seton in the management of anorectal fistulas. Dis Colon Rectum 36:573–577
Christensen A, Nilas L, Christiansen J (1986) Treatment of transsphincteric anal fistulas by the seton technique. Dis Colon Rectum 29:454–455
Mentes BB, Oktemer S, Tezcaner T, Azili C, Leventoğlu S, Oğuz M (2004) Elastic one-stage cutting seton for the treatment of high anal fistulas: preliminary results. Tech Coloproctol 8:159–162
Hanley PH (1978) Rubber band seton in the management of abscess-anal fistula. Ann Surg 187:435–437
Culp CE (1984) Use of penrose drains to treat certain anal fistulas: a primary operative seton. Mayo Clin Proc 59:613–617
Hammond TM, Knowles CH, Porrett T, Lunniss PJ (2006) The snug seton: short and medium term results of slow fistulotomy for idiopathic anal fistulae. Colorectal Dis 8:328–337
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Leventoğlu, S., Ege, B., Menteş, B.B. et al. Treatment for horseshoe fistula with the modified Hanley procedure using a hybrid seton: results of 21 cases. Tech Coloproctol 17, 411–417 (2013). https://doi.org/10.1007/s10151-012-0952-0
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DOI: https://doi.org/10.1007/s10151-012-0952-0