Combined Parks Seton placement and transanal sphincterotomy improves outcome and reduces recurrence in high-position complex anal fistula.

OBJECTIVE

To assess the clinical efficacy of combined Parks Seton placement and transanal sphincterotomy for high-position complex anal fistula and identify factors influencing postoperative recurrence.

METHODS

This retrospective study included 186 patients with high-position complex anal fistula treated between January 2018 and January 2023. Ninety-six patients received combined Parks Seton placement and transanal sphincterotomy (combined group), while 90 underwent only Parks Seton placement (control group). Clinical outcomes were compared based on surgical time, blood loss, wound healing time, functional recovery, and recurrence rate. Pearson correlation analysis identified risk factors for recurrence.

RESULTS

The combined group showed significantly improved outcomes in surgical time, blood loss, wound healing time, and scar area (all P < 0.001). Functional recovery and SF-36 quality of life scores were also significantly better (both P < 0.05). The total effective rate in the combined group was higher (P = 0.003), while the recurrence rate was lower (P < 0.001). Correlation analysis revealed that diabetes, treatment plan, postoperative bleeding score, disease duration, scar area, and pain score were significantly associated with recurrence (all P < 0.05). Multivariate analysis identified diabetes (P < 0.001) and disease duration (P = 0.001) as significant risk factors for recurrence, while treatment protocol, scar area, pain score, and bleeding score showed weaker or non-significant associations (all P > 0.05).

CONCLUSION

Combined Parks Seton placement and transanal sphincterotomy effectively treat high-position complex anal fistula, reducing recurrence while preserving sphincter function. Diabetes, longer disease duration, larger scars, and early postoperative pain/bleeding are significant risk factors for recurrence.