Document Detail


Seton drainage prior to transanal advancement flap repair: useful or not?
MedLine Citation:
PMID:  20645104     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
INTRODUCTION: Transanal advancement flap repair (TAFR) provides a useful tool in the treatment of high transsphincteric fistulas. Recent studies indicate that TAFR fails in one out of three patients. Until now, no definite predictive factor for failure has been identified. Although some authors have reported that preoperative seton drainage might improve the outcome of TAFR, this could not be confirmed by others. We conducted the present study to assess the influence of preoperative seton drainage on the outcome of TAFR in a relatively large series.
METHODS: Between December 1992 and June 2008, a consecutive series of 278 patients [M/F = 179:99, median age 46 years (range, 19-73 years)] with cryptoglandular, transsphincteric fistula, passing through the upper or middle third of the external anal sphincter underwent TAFR. Patients were recruited from the colorectal units of two university hospitals (Erasmus Medical Center, Rotterdam, n = 211; and Leiden University Medical Center, Leiden, n = 67). Baseline characteristics did not differ between the two clinics. Sixty-eight of these patients underwent preoperative seton drainage for at least 2 months and until the day of the flap repair.
RESULTS: Median healing time was 2.2 months. In patients without preoperative seton drainage, the healing rate was 63%, whereas the healing rate was 67% in patients who underwent preoperative seton drainage. This difference was not statistically significant. No differences in healing rates were found between the series from Leiden and Rotterdam.
CONCLUSION: Preoperative seton drainage does not improve the outcome of TAFR.
Authors:
Litza E Mitalas; Jan J van Wijk; Martijn P Gosselink; Pascal Doornebosch; David D E Zimmerman; W Rudolph Schouten
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Publication Detail:
Type:  Clinical Trial; Journal Article; Multicenter Study     Date:  2010-07-20
Journal Detail:
Title:  International journal of colorectal disease     Volume:  25     ISSN:  1432-1262     ISO Abbreviation:  Int J Colorectal Dis     Publication Date:  2010 Dec 
Date Detail:
Created Date:  2010-11-05     Completed Date:  2011-03-15     Revised Date:  2013-05-29    
Medline Journal Info:
Nlm Unique ID:  8607899     Medline TA:  Int J Colorectal Dis     Country:  Germany    
Other Details:
Languages:  eng     Pagination:  1499-502     Citation Subset:  IM    
Affiliation:
Colorectal Research Group, Department of Surgery, Erasmus Medical Center, H 181 's Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands.
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Digestive System Surgical Procedures / methods*
Drainage / methods*
Humans
Middle Aged
Prognosis
Recovery of Function
Rectal Fistula / surgery*
Surgical Flaps*
Treatment Failure
Wound Healing
Young Adult
Comments/Corrections
Comment In:
Int J Colorectal Dis. 2011 Nov;26(11):1495   [PMID:  21279366 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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