Comparative Analysis of Directional Snare vs Cutting Seton for High Anal Fistula Treatment.

BACKGROUND The cutting seton (CS) method uses a suture knot placed in the track of an anal fistula around the anal sphincter, which is tied using tension. This study aimed to compare outcomes in 60 patients with high anal fistula treated with a disposable directional snare or CS method. MATERIAL AND METHODS Sixty patients with high anal fistula were selected and randomly divided into 2 groups, with 30 patients in each group. One group was treated by directional CS with a disposable fistula snare (DFCS), and the other group underwent CS. The 2 groups were compared in terms of clinical efficacy, operation time, rubber band fall-off time, wound healing time, visual analogue scale (VAS), anal function, recurrence rate, and patient satisfaction. RESULTS In the CS group, wound healing and operation time were longer than in the DFCS group (29.5±9.2 vs 37.2±10.7; 25.5±4.6 vs 29.9±5.1, P<0.05). In the 7 days after surgery, the VAS score of the DFCS group was markedly lower than that of the CS group (3.4±0.2 vs 4.9±0.1, P<0.05). Three months after surgery, Wexner score, anal resting pressure, and anal maximal contraction pressure in the DFCS group were remarkably improved, compared with in the CS group (P<0.05), and patients in the DFCS group were more satisfied (8.83±0.79 vs 5.51±0.37, P<0.05). CONCLUSIONS The findings from this study showed that disposable directional snare can not only ensure the curative effect, but can also maintain the fine anal function more exactly, facilitate the thread tightening process, and reduce patient pain.