Efficacy and Patient Outcomes of Hybrid Rubber Seton in the Management of Complex Anal Fistulas

Author(s): Tariq Akhtar Khan, Mohammad Ali, Krishna Pada Saha, Md. Nashir Uddin, Md. Lutful Kabir Khan, Nunjirul Muhsenin, Nazmun Nahar, Sawantee Joarder, Md. Kuddus Ali Khan

Background: Complex anal fistulas present a significant surgical challenge due to high recurrence rates and the risk of fecal incontinence. The hybrid rubber seton technique, combining features of both cutting and drainage setons, has emerged as a promising approach to improve healing while preserving sphincter function. This study evaluates the efficacy and patient outcomes of hybrid rubber seton placement in the management of complex anal fistulas.

Methods: This prospective observational study was conducted from July 2021 to June 2024 across six hospitals in Bangladesh, including 94 patients with complex anal fistulas. Operative details were documented using the St Mark’s Hospital fistula operation note format. Post-operative outcomes, including seton drop time, wound healing duration, recurrence rates, and complications, were recorded. Statistical analysis was performed using SPSS version 25.

Results: The majority of patients (78.7%) had high trans-sphincteric fistulas. The median seton drop time was 6 weeks, and 59.6% of patients required more than 60 days for complete wound healing. The recurrence rate within six months was 12.8%, and no cases of permanent fecal incontinence were reported. Reactionary hemorrhage occurred in 27.7% of patients, but no infective complications were observed. Overall, 74.5% of patients reported being very satisfied with the procedure.

Conclusion: The hybrid rubber seton is an effective and safe technique for managing complex anal fistulas, offering favorable healing rates with minimal risk of incontinence. It remains a viable treatment option, balancing fistula closure and sphincter preservation. Further research should focus on long-term functional outcomes and comparative studies with newer techniques.