Comparison of Healing Time, Recurrence Rate, Incontinence, and Quality of Life Following Endorectal Advancement Flap versus Cutting Seton Insertion for Trans-Sphincteric High Type Anal Fistula: A 5-Year Retrospective Cohort Study.

BACKGROUND

According to the high prevalence of anal fistulas and the recurrence of the disease following surgery, different methods have been suggested for appropriate treatment of this disease; however, there is no consensus on the most effective method. This study aimed to compare the healing time, recurrence rate, fecal incontinence, and quality of life associated with endorectal advancement flap versus cutting Seton insertion for high-type anal fistulas.

METHODS

In this retrospective cohort study, 81 patients with trans-sphincteric high-type perianal fistula, including 53 men and 28 women, were studied for 5 years (2019-2024). The Patients included in this study were divided into two categories. One of them underwent an endorectal advancement flap, and the other one underwent cutting Seton insertion. SPSS software was used for statistical analysis.

RESULTS

37 (45.7%) patients underwent endorectal advancement flap, and 44 (54.3%) patients had cutting Seton insertion. There was no significant difference in recurrence rate, incontinence, and quality of life between the two groups, while the healing time in the group that underwent endorectal advancement flap was significantly different and shorter in comparison with the patients who underwent cutting Seton insertion (30 versus 60 days, respectively, P=0.016).

CONCLUSION

Our study results showed a more significant reduction in the healing time with endorectal advancement flap surgery than the cutting Seton insertion procedure in patients who suffered from trans-sphincteric high-type anal fistula without any significant difference regarding the recurrence rate, incontinence, and quality of life.