Nigam′s Modified Roeder′s Knot in Cutting Seton in High Fistula-in-ano Prevents Rethreading and Reapplication of Seton

Abstract

Background: Fistula-in-ano is known for its recurrence and other complications after surgery, especially in high fistulae cases. Use of a cutting seton is an accepted mode of treatment for high fistula-in-ano cases. Nigam′s modified Roeder′s knot (NMRK) makes the cutting seton adjustable. The aim of our study is to investigate the results of NMRK application in cutting seton in relation to reapplication, rethreading, postoperative inconvenience to the patient, and postoperative complications. Objectives: To determine whether the NMRK in cutting seton reduces the chances of seton reapplication and postoperative complications in high fistula-in-ano. Design: Squire---Quality Improvement Study. Setting: Patients admitted in various hospitals in Gurugram, Haryana, India. Materials, Methods, and Main Outcome Measures: Eighty high fistula-in-ano patients underwent fistulactomies using the NMRK in both the cutting and adjustable setons between January 2001 and January 2019. Informed consent was obtained from each patient. The patients were evaluated for seton reapplication, inconvenience, recurrence, fecal incontinence, and other postoperative complications. Sample Size: Eighty high fistula-in-ano patients underwent fistulactomies using the NMRK in both the cutting and adjustable setons Results: In our series, no patient suffered fecal incontinence. Three patients (3.75%) had gas incontinence, which gradually stopped within 2 weeks. Most of the setons took 4– 6 weeks to drop. The healing time was 6– 8 weeks for majority of the patients. Two patients (2.50%) developed recurrence after surgery. No patient required readmission or anesthesia for seton reapplication. Conclusion: If the cutting seton with the NMRK is retightened every week, then the drop time of the seton and the total healing time decrease, resulting in reduced incidence of inconvenience, pain, fecal incontinence, and recurrence. Rethreading or reapplication of seton is not required. Limitations: Our study includes only uncomplicated high fistula-in-ano cases. It also excludes complex fistulae, watercan perineum, and fistulae with inflammatory bowel disease or cancer. Conflict of Interest: None. Keywords: Cutting seton, fecal incontinence, fistula-in-ano, Nigam′s modified Roeder′s knot, recurrence