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Cutting seton for the treatment of cryptoglandular fistula-in-ano: a systematic review and meta-analysis

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Abstract

Background

The use of cutting seton (CS) for the management of cryptoglandular fistula-in-ano has remained controversial because of reports of fecal incontinence, postoperative pain, and extended healing time. The aim of this review was to provide the first synthesis of studies investigating the use of CS for the treatment of cryptoglandular fistula-in-ano.

Methods

MEDLINE, Embase, and CENTRAL were searched up to October 2022. Randomized controlled trials and observational studies comparing CS with alternative interventions were included, along with single-arm studies evaluating CS alone. The primary outcome was fistula-in-ano recurrence, and secondary outcomes included incontinence, healing time, proportion with complete healing, and postoperative pain. Inverse variance random-effects meta-analyses were used to pool effect estimates.

Results

After screening 661 citations, 29 studies were included. Overall, 1513 patients undergoing CS (18.8% female, mean age: 43.1 years) were included. Patients with CS had a 6% (95% CI: 3–12%) risk of recurrence and a 16% (95% CI: 5–38%) risk of incontinence at 6 months. CS patients had an average healing time of 14.6 weeks (95% CI: 10–19 weeks) with 73% (95% CI: 48–89%) of patients achieving complete healing at 6 months postoperatively. There was no difference in recurrence between CS and fistulotomy, advancement flap, two-stage seton fistulotomy, or draining seton.

Conclusions

Overall, this analysis shows that CS has comparable recurrence and incontinence rates to other modalities. However, this may be at the expense of more postoperative pain and extended healing time. Further comparative studies between CS and other modalities are warranted.

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Data/Code availability

All data generated or analyzed during this study are included in this published article and its supplementary information files. Files can be provided by the corresponding author upon request.

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Authors and Affiliations

  1. Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada

    J. Khamar

  2. Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada

    A. Sachdeva

  3. Division of General Surgery, Department of Surgery, McMaster University, St. Joseph’s Healthcare, 50 Charlton Avenue East, Hamilton, ON, L8N 4A6, Canada

    T. McKechnie, Y. Lee, L. Tessier, D. Hong & C. Eskicioglu

  4. Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada

    T. McKechnie

  5. Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA

    Y. Lee

  6. Division of General Surgery, Department of Surgery, St. Joseph’s Healthcare, Hamilton, ON, Canada

    D. Hong & C. Eskicioglu

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Conception and design of the study—All authors Acquisition of data—J.K., A.S. Analysis and interpretation of data—All authors. Drafting and revision of the manuscript—All authors. Approval of the final version of the manuscript—All authors Agreement to be accountable for all aspects of the work—All authors.

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Khamar, J., Sachdeva, A., McKechnie, T. et al. Cutting seton for the treatment of cryptoglandular fistula-in-ano: a systematic review and meta-analysis. Tech Coloproctol 28, 12 (2024). https://doi.org/10.1007/s10151-023-02886-z

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