Rajneesh Kumar
Punjab Institute of Medical Sciences [PIMS]Punjab,India
Title: Tightening of seton using Roeder’s knot in Complex Fistula - in - ano : with knot pusher (specially designed)
Biography
Biography: Rajneesh Kumar
Abstract
Objective: There are two main complications after surgery of complex fistula-in-ano: i.e. faecal incontinence and recurrence.
Summary Background Data: To prevent incontinence of stools and flatus we require saving the anal sphincter muscle with tightening of seton using Roeder’s knot with specially designed Rajneesh’s seton knot pusher.
Method: The study includes 40 patients who had undergone treatment of complex and high fistula-in-ano at Civil Hospital, Jalandhar from January, 2010 to September 2012 and from September, 2012 to January, 2017 at Punjab Institute of Medical Sciences (PIMS).
Results: 40 patients of complex fistula-in-ano were taken up for study with the age (mean ± standard deviation) of 35 ± 10.6 years. The Roeder’s knot was tightened with a median of 5 times (3-10 times) as OPD procedure. All the patients were on follow up for minimum period of 6 months and none of the patient had any incontinence. Recurrence occurred in one case. There was breakage of thread at knot site with knot pusher in two cases.
Conclusion: Tightening of seton using Roeder’s knot with Rajneesh’s knot pusher is safe, cost effective treatment for complex fistula-in-ano and follow up is easy. Tightening of fistula is an outdoor procedure rather than replacing the loose seton. Patients were on follow up every week and seton with Roeder’s knot tightened in O.P.D after application of 2% xylocain jelly. Incontinence was assessed according to wexner’s score.