Seton (Loose, Cutting, Chemical)

Authors

Type of study

Chemical seton (n)

Follow-up months

Minor incontinence (n/%)

Recurrence %

Ho et al. [6]

RCT

3/6.5

Shukla et al. [19]

RCT

155

8/5.1

Mohite et al. [73]

Prospective

114

6–30

Srivastava et al. [75]

Clinical trial

2/6.6

3.33

Panigrahi et al. [76]

Prospective

9–12

7/14

5.88

Complications

Complications following ksharasutra usually are severe burning pain, redness and induration, abscess [73], and slippage of thread. Transient burning pain is the commonest complication and is seen in most patients [19] following ksharasutra probably due to alkaline extracts in the thread. Severe burning pain was seen in over 30 % of patients [73]. Post-procedure abscesses needing drainage have been described [73, 75] needing drainage.

Evidence and Recommendations

Ksharasutra is a safe and effective method to treat fistula-in-ano of cryptoglandular origin. It can be carried out in the outpatient setting and patients can be ambulatory soon. Recurrence rates and incontinence rates are low, with complications such as abscess and burning pain after the procedure. The mode of action is by drainage of pus, slow and constant cutting through of the fistulous tract and the sphincter, and most importantly chemical action on the unhealthy tissue and antiseptic effect of the medicinal extracts. Analysis of a single RCT in a Cochrane review did not reveal any benefit compared to a fistulotomy (Evidence: 2A). It is extensively used in the Indian Subcontinent however not in the Western world.

References

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