Cutting seton as salvage strategy for complex or recurrent anal fistula: Single-tertiary center 10-year experience with 207 patients

Table 1 Baseline demographics and clinical characteristics (n = 207), n (%)/mean ± SD

Feature	Values
Age in years	48 (22-89)
Sex
Male	176 (85.0)
Female	31 (15.0)
BMI in kg/m2	30.8 ± 5.8
DM	41 (19.8)
Smoking	36 (17.4)
Steroids use	6 (2.9)
Preoperative Pezzer catheter insertion	21 (10.1)
Previous anal surgery for fistula	117 (56.5)
Hemorrhoidectomy	13 (6.3)
Lateral sphincterotomy	3 (1.4)
Previous abscess drainage	125 (60.4)

BMI: Body mass index; DM: Diabetes mellitus.

Table 2 Anal fistula characteristics, n (%)/mean ± SD

Characteristic	Values
Type of fistula
High	102 (49.3)
Low	85 (41.1)
Horseshoe	14 (6.8)
Duration of history in days	22.34 ± 30.7
Recurrent fistula	52 (25.1)
Fistula type based on MRI
Supra-sphincteric	1 (0.5)
Extra-sphincteric	1 (0.5)
Trans-sphincteric	14 (6.8)
Inter-sphincteric	36 (17.4)
Low-sphincteric	4 (1.9)
Horseshoe sphincteric	3 (1.4)
Level of internal opening
Below anal crypts	23 (11.1)
Above anal crypts	17 (8.2)
At anal crypts	125 (60.4)
Postoperative Pezzer insertion	14 (6.8)
Position of internal opening
Anterior	36 (17.4)
Posterior	78 (37.7)
Right lateral	42 (20.3)
Left lateral	49 (23.7)
Distance external opening from anal verge in cm	3.90 ± 9.41
Position of external opening
Anterior	37 (17.9)
Posterior	63 (30.4)
Right lateral	67 (32.4)
Left lateral	75 (36.2)

MRI: Magnetic resonance imaging.

Table 3 Univariate and multivariate logistic regression analysis for the parameters affecting recurrence (n = 207) for different parameters

Fistula characteristics	Univariate		Multivariate1
	P value	OR (95%CI)	P value	OR (95%CI)
Duration of history	0.002a	0.134 (0.038-0.467)	0.566	0.593 (0.100-3.533)
Internal opening
Below anal crypts	0.320	0.353 (0.045-2.754)	NA	NA
Above anal crypts	0.874	1.133 (0.241-5.321)	NA	NA
At anal crypts	0.038a	3.280 (1.068-10.074)	0.056	4.212 (0.966-18.373)
postoperative Pezzer catheter insertion	0.004a	5.752 (1.730-19.119)	0.021a	8.330 (1.384-50.136)
Position of internal opening
Anterior	0.624	0.727 (0.203-2.601)	NA	NA
Posterior	0.022a	0.232 (0.066-0.810)	0.067	0.242 (0.053-1.103)
Right lateral	0.795	0.860 (0.275-2.690)	NA	NA
Left lateral	0.345	1.589 (0.608-4.153)	NA	NA
Incontinence postoperative	0.018a	3.075 (1.216-7.775)	0.399	1.726 (0.486-6.132)
Tightening	0.035a	2.627 (1.073-6.435)	0.099	0.197 (0.029-1.356)

^aP ≤ 0.05.

¹All variables with P < 0.05 were included in the multivariate analysis.

OR: Odds ratio; CI: Confidence interval; NA: Not available.

Table 4 Preoperative and postoperative incontinence status according to Cleveland Clinic Fecal Incontinence Score (n = 207), n (%)

Status	Frequency	Preoperative	Postoperative	P value
Incontinence		18 (8.7)	43 (20.8)
Gas incontinence	Rarely	7 (3.4)	11 (5.3)
	Sometimes	11 (5.3)	21 (10.1)
Liquid incontinence	Rarely	5 (2.4)	7 (3.4)
	Sometimes	3 (1.4)	7 (3.4)
Solid incontinence	Rarely	2 (1.0)	1 (0.5)
	Sometimes	0	1 (0.5)
Seepage	Rarely	1 (0.5)	3 (1.4)
	Sometimes	5 (2.4)	7 (3.4)
Pad use	Rarely	4 (1.9)	4 (1.9)
	Sometimes	0	0
Lifestyle effect	Rarely	6 (2.9)	5 (2.4)
	Sometimes	0	4 (1.9)
CCFIS, mean (95%CI)		1.62 (1.14-2.10)	2.12 (1.58-2.66)	0.197

In the Cleveland Clinic Fecal Incontinence Score: Rare defined as once every 4 weeks and sometimes defined as more than once every 4 weeks but less than once per week. CCFIS: Cleveland Clinic Fecal Incontinence Score; CI: Confidence interval.

Table 5 Postoperative pain assessed using the Visual Analog Scale (n = 180), n (%)

Postoperative pain	n (%)
Mild (1-3)	161 (89.4)
Moderate (4-6)	15 (8.3)
Severe (7-10)	4 (2.2)
Mean (95%CI)	2.39 (2.21-2.57)

CI: Confidence interval.