Treatment for horseshoe fistula with the modified Hanley procedure using a hybrid seton: results of 21 cases

• Published in: Techniques in coloproctology 2013-08, Vol.17 (4), p.411-417
• Main Authors: Leventoğlu, S., Ege, B., Menteş, B. B., Yörübulut, M., Soydan, S., Aytaç, B.
• Format: Article
• Language: English
• Subjects: Abdominal Surgery; Abscess - complications; Abscess - diagnosis; Abscess - surgery; Adult; Aged; Cohort Studies; Colorectal Surgery; Diffusion Magnetic Resonance Imaging - methods; Digestive System Surgical Procedures - instrumentation; Digestive System Surgical Procedures - methods; Female; Follow-Up Studies; Gadolinium; Gastroenterology; Gloves, Surgical; Humans; Length of Stay; Male; Medicine; Medicine & Public Health; Middle Aged; Original Article; Proctology; Rare Diseases; Rectal Fistula - complications; Rectal Fistula - diagnosis; Rectal Fistula - surgery; Rectum - surgery; Retrospective Studies; Risk Assessment; Statistics, Nonparametric; Surgery; Treatment Outcome; Wound Healing - physiology; Young Adult
• ISSN: 1123-6337; 1128-045X
• DOI: 10.1007/s10151-012-0952-0

Background The aim of the present study was to document our recent experience in managing horseshoe fistula of cryptoglandular origin with a modification of the Hanley procedure using a hybrid elastic one-stage cutting seton. Methods Surgical outcomes of the modified Hanley procedure for horseshoe fistulae using a seton from 2004 through 2010 were analyzed. The seton fashioned from a surgical glove was tied around the sphincter under less tension than a traditional cutting seton, hence the definition of “hybrid seton”. In addition to excision of the superficial segments of the lateral tracts, deeper extensions into the ischiorectal spaces were curetted, and Penrose drains were placed. Results All of the patients were discharged on the first postoperative day. None required readmission or needed narcotic analgesics after discharge. Complete healing was achieved in all 21 cases at 8.0 ± 3.22 weeks postoperatively. Patients were able to return to regular work activity in 3.5 ± 1 weeks. The postoperative Cleveland Clinic Incontinence Score did not differ significantly from the preoperative score ( p  = 0.317, Wilcoxon’s test). Recurrent fistula was noted in a single patient (4.8 %) after a mean follow-up of 20.9-months. Conclusions The use of the hybrid elastic seton is a useful and safe additional modification for the treatment of horseshoe fistulae with the Hanley technique.