Comparison of healing time, recurrence rate, incontinence, and quality of life following Endorectal Advancement Flap versus Cutting Seton insertion for high type anal fistula: A 5-years Cohort Retrospective Study

Abstract

Introduction: According to the high prevalence of anal fistulas and the recurrence of the disease following surgery, different methods have been suggested for appropriate treatment of this disease; however, there is no consensus on the most effective method. The aim of this study was to compare the healing time, recurrence rate, fecal incontinence, and quality of life associated with endorectal advancement flap versus cutting Seton insertion for high type anal fistulas. Methods: In this retrospective cohort study, 81 patients with high type perianal fistula including 53 men and 28 women were studied for 5 years (2019-2024). The Patients included in this study were divided into two categories. One of them underwent endorectal advancement flap and the other one underwent cutting Seton insertion. SPSS software was used for statistical analysis. Results: 37 (45.7%) patients underwent endorectal advancement flap and 44 (54.3%) patients had cutting Seton insertion. There was no significantly difference in recurrence rate, incontinence, and quality of life between two groups while the healing time in the group underwent endorectal advancement flap was significantly different and shorter in comparison to the patients underwent cutting Seton insertion (30 versus 60 days, respectively, P-value= 0.016). Conclusion: Our study results showed a more significant reduction in the healing time with endorectal advancement flap surgery than the cutting Seton insertion procedure in patients suffered from high type anal fistula without any significant difference regarding the recurrence rate, incontinence and quality of life.