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Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet]. York (UK): Centre for Reviews and Dissemination (UK); 1995-.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet].

Incontinence rates after cutting seton treatment for anal fistula

Review published: 2009.

Bibliographic details: Ritchie RD, Sackier JM, Hodde JP.  Incontinence rates after cutting seton treatment for anal fistula. Colorectal Disease 2009; 11(6): 564-571. [PubMed: 19175623]

Quality assessment

This review concluded that the high rates of anal incontinence for anal fistula that used cutting setons suggested this therapy can damage the continence musculature. Possible inappropriate analysis of studies of weak design and unknown quality and the possibility of bias and error suggested the authors' conclusions should be viewed with caution. Full critical summary

Abstract

OBJECTIVE: To determine the incidence of anal incontinence after the use of cutting seton treatment for anal fistula.

METHOD: Literature searches were performed on PubMed, MEDLINE and Google Scholar using the words 'cutting seton(s)', 'seton(s)' and 'anal fistula'. An analysis of the data in the collected references was performed.

RESULTS: The average rate of incontinence following cutting seton use was 12%. The rate of incontinence increased as the location of the internal opening of the fistula moved more proximally. In the studies that described the types of incontinence, liquid stool was the most common followed closely by flatus incontinence. Incontinence associated with the treatment of fistulas defined as nonspecific cryptoglandular in nature was 18%.

CONCLUSION: The high incontinence rates that result from the use of cutting setons suggest that this commonly used therapy can damage the continence musculature. Other techniques that do not involve cutting the sphincter, when available, should be preferred, especially for higher fistulas.

CRD has determined that this article meets the DARE scientific quality criteria for a systematic review.

Copyright © 2014 University of York.

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