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CC BY-NC-ND 4.0 · Journal of Coloproctology 2021; 41(03): 308-315
DOI: 10.1055/s-0041-1730039
Review Article

The Use of Seton as a Bridge to Definitive Ligation of the Intersphincteric Fistula Tract Procedure for Fistula-in-ano: A Systematic Review and Meta-analysis

Carlos Placer-Galán 
1   Colorectal Surgery Unit, Department of General and Digestive Surgery, Donostia University Hospital, Biodonostia (Gastrointestinal Diseases Group), San Sebastián, Spain
,
Jose Mª Enriquez-Navascués 
1   Colorectal Surgery Unit, Department of General and Digestive Surgery, Donostia University Hospital, Biodonostia (Gastrointestinal Diseases Group), San Sebastián, Spain
,
Tania Pastor-Bonel 
1   Colorectal Surgery Unit, Department of General and Digestive Surgery, Donostia University Hospital, Biodonostia (Gastrointestinal Diseases Group), San Sebastián, Spain
,
Ignacio Aguirre-Allende 
1   Colorectal Surgery Unit, Department of General and Digestive Surgery, Donostia University Hospital, Biodonostia (Gastrointestinal Diseases Group), San Sebastián, Spain
,
Yolanda Saralegui-Ansorena 
1   Colorectal Surgery Unit, Department of General and Digestive Surgery, Donostia University Hospital, Biodonostia (Gastrointestinal Diseases Group), San Sebastián, Spain
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Abstract

Background There is still controversy over the usefulness of seton placement prior to the ligation of the intersphincteric fistula tract (LIFT) surgery in the management of anal fistula.

Objective To evaluate the impact of preoperative seton placement on the outcomes of LIFT surgery for the management of fistula-in-ano.

Design systematic review and meta-analysis.

Data Sources A search was performed on the MEDLINE (PubMed), EMBASE, Scopus, Web of Science, Cochrane Library and Google Scholar databases.

Study Selection Original studies without language restriction reporting the primary healing rates with and without seton placement as a bridge to definitive LIFT surgery were included.

Intervention The intervention assessed was the LIFT with and without prior seton placement.

Main Outcome Measures The main outcome was defined as the primary healing rate with and without the use of seton as a bridge to definitive LIFT surgery.

Results Ten studies met the criteria for systematic review, all retrospective, with a pooled study population of 772 patients. There were no significant differences in the percentages of recurrence between patients with and without seton placement (odds ratio [OR] 1.02; 95% confidence interval [CI] 0.73–1.43: p = 0.35). The I2 value was 9%, which shows the homogeneity of the results among the analyzed studies. The 10 included studies demonstrated a weighted average overall recurrence of 38% (interquartile range [IQR] 27–42.7%), recurrence with the use of seton was 40% (IQR 26.6–51.2%), and without its use, the recurrence rate was 51.3% (IQR 31.3–51.3%)

Limitations The levels of evidence found in the available literature were relatively fair, as indicated after qualitative evaluation using the Newcastle-Ottawa scale and the Attitude Heading Reference System (AHRS) evidence levels.

Conclusions Our meta-analysis suggests that the placement of seton as a bridge treatment prior to LIFT surgery does not significantly improve long-term anal fistula healing outcomes. Ligation of the intersphincteric fistula tract surgery can be performed safely and effectively with no previous seton placement.

International prospective register of systematic reviews—PROSPERO registration number: CDR42020149173.

Keywords

anal fistula - seton - LIFT - intersphincteric

Supplementary Material



Publication History

Received: 28 August 2020

Accepted: 15 January 2021

Article published online:
19 July 2021

© 2021. Sociedade Brasileira de Coloproctologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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