Partial Fistulotomy and Application of Modified Cutting Seton in the Treatment of Complex Perianal Fistula - Our Experience in Rajshahi Medical College Hospital

Background: Complex perianal fistula is very challenging to treat, often requires procedures like partial fistulotomy followed by the application of a seton to prevent fecal incontinence and recurrence. Objective: This study aimed to assess the clinical outcomes of employing a modified cutting seton following partial fistulotomy in respect to recurrence and incontinence, for treating complex perianal fistula in a tertiary hospital setting. Method: A longitudinal study was conducted involving (n=239) patients admitted to the Department of Surgery in Rajshahi Medical College Hospital over a 4-years period from May 2020 to April 2024. Purposive sampling was utilized, with patient data collected from histories, physical examinations, investigations, treatment sheets, and postoperative follow-up using semi-structured questionnaires. Results: The study comprised predominantly male patients (79.08%), with the majority falling within the 35-45 age group (54.39%). Notable findings included a significant proportion with a history of perianal abscess (24.69%), with many having sought treatment from non-medical sources (71.19%). Recurrence rates at 3, 6 and 12- months post-procedure was low (1.67%, 2.09% and 3.35% respectively), with minimal incidences of incontinence (7.11% at 3 months, 3.35% at 6 months and 1.26% at 12 months). Conclusion: The study reflects the outcomes of partial fistulotomy and application of modified cutting setons in the treatment of complex perianal fistula, demonstrating minimal side effects in the clinical context.