İpar Selin Demirci, Samet Şahin
Karya Journal of Health Science - 2026;7(1):1-6
Objective: Anal fistulas, abnormal tracts that form between the anal canal and the perianal skin, frequently require surgical intervention. In our study, we evaluated preoperative and postoperative pain and functional impairment after fistulotomy or seton placement in patients diagnosed with low transsphincteric anal fistulas. Method: A retrospective cohort study was conducted on patients treated at Muğla Training and Research Hospital between January 1, 2022, and December 1, 2024. Patients with a history of proctologic surgery, complex fistulas, or concomitant diseases that could cause functional loss were excluded. Patients' pain and function were assessed preoperatively at 1 week, and 1 month postoperatively using the Visual Analog Scale (VAS) and the World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0). Results: A total of 117 patients were included in the study: 62 fistulotomies and 55 setons. The VAS score increased significantly in the fistulotomy group at week 1 and decreased significantly at month 1 (p<0.001). There was no significant change in the VAS score in the seton group (p>0.05). The WHODAS 2.0 total score and its subscales, including mobility, activities of living, and community participation, assessed at 1 week and 1 month postoperatively, increased significantly in the fistulotomy group. (p<0.05). The WHODAS 2.0 score increased significantly in the seton group at week 1 (p<0.001). Conclusion: Although fistulotomy causes more pain in the early period, it provides better long-term results in terms of pain and function. While initially more tolerable, seton placement carries the risk of permanent pain and loss of function. When making a surgical decision, not only anatomical improvement but also patient quality of life should be considered.
