Influence of seton configuration, thickness, and laxity on patient comfort in chronic perianal fistula: a prospective comparative study.

IF 2.3 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

International Journal of Colorectal Disease Pub Date : 2025-08-25 DOI:10.1007/s00384-025-04985-9

J Barambio, Ana Leon-Bretscher, María Ramírez Bescos, Paula Soto García, Paloma Gadea Uria, Teresa Laloumet Garcimartin, Elena Viejo Martinez, Felipe Acedo Fernandez de Pedro, Patricia Ortega Domene, Alicia Ruiz de la Hermosa, María Luisa De Fuenmayor-Valera, Gloria Paseiro-Crespo

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Abstract

Purpose: To determine how seton configuration, thickness, and laxity influence patient comfort and clinical outcomes in the management of chronic perianal fistulas.

Methods: A prospective single-center study was conducted involving 33 patients (53 setons). Both intraindividual paired (n = 20) and independent group analyses (n = 13) were performed. Setons were categorized by configuration (O-shaped vs. V-shaped), thickness (1.5 mm vs. 2.5 mm), and laxity (≤ 2 cm vs. > 2 cm from the anal verge). Patient-reported outcomes were assessed using structured questionnaires evaluating sitting discomfort, discharge, sexual impact, and fecal incontinence.

Results: O-shaped setons caused significantly less sitting discomfort than V-shaped ones (50.0% vs. 80.0%, p = 0.021). Excess laxity (> 2 cm) was associated with increased discharge (86.4% vs. 51.6%, p = 0.008), sexual impact (42.1% vs. 10.3%, p = 0.016), and fecal incontinence (66.7% vs. 10.0%, p = 0.041). Thicker setons (2.5 mm) showed a non-significant trend toward more pain (42.9% vs. 17.9%, p = 0.080).

Conclusion: Seton configuration and laxity significantly affect patient comfort. O-shaped setons and shorter laxity (≤ 2 cm) are preferable for reducing discomfort. These findings support evidence-based seton selection, although larger multicenter studies are needed to confirm these results.

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seton结构、厚度和松弛度对慢性肛周瘘患者舒适度的影响：一项前瞻性比较研究。

目的：探讨慢性肛周瘘管的结构、厚度和松弛度对患者舒适度和临床结果的影响。方法：采用前瞻性单中心研究，纳入33例患者（53组）。进行了个体内配对分析（n = 20）和独立组分析（n = 13）。根据形态（o形vs. v形）、厚度（1.5 mm vs. 2.5 mm）和松弛度（≤2 cm vs.距离肛门边缘2 cm）对肛门进行分类。患者报告的结果采用结构化问卷评估坐姿不适、排泄、性影响和大便失禁。结果：o型坐垫引起的坐位不适明显小于v型坐垫（50.0% vs. 80.0%, p = 0.021）。过度松弛（bbb2.0 cm）与排出量增加（86.4% vs. 51.6%, p = 0.008）、性影响（42.1% vs. 10.3%, p = 0.016）和大便失禁（66.7% vs. 10.0%, p = 0.041）相关。较厚的牙周（2.5 mm）疼痛加重的趋势不显著（42.9% vs. 17.9%, p = 0.080）。结论：Seton结构和松弛程度对患者舒适度有显著影响。o型筋膜和较短的松驰度（≤2 cm）可减轻不适。这些发现支持基于证据的seton选择，尽管需要更大规模的多中心研究来证实这些结果。

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来源期刊

International Journal of Colorectal Disease 医学-外科

CiteScore

4.90

自引率

3.60%

发文量

206

审稿时长

3-8 weeks

期刊介绍： The International Journal of Colorectal Disease, Clinical and Molecular Gastroenterology and Surgery aims to publish novel and state-of-the-art papers which deal with the physiology and pathophysiology of diseases involving the entire gastrointestinal tract. In addition to original research articles, the following categories will be included: reviews (usually commissioned but may also be submitted), case reports, letters to the editor, and protocols on clinical studies. The journal offers its readers an interdisciplinary forum for clinical science and molecular research related to gastrointestinal disease.