Tightening of seton using Roeders knot in complex fistula-in-ano: With knot pusher (specially designed)

9^th International Congress on Surgery

August 27-28, 2018 Tokyo, Japan

Rajneesh Kumar

Punjab Institute of Medical Sciences, India

Keynote: Surgery

Abstract :

Background & Aim: To prevent incontinence of stools and flatus we require saving the anal sphincter muscle with tightening of seton using Roederâ??s knot with specially designed Rajneeshâ??s seton knot pusher. There are two main complications after surgery of complex fistula-in-ano i.e. fecal incontinence and recurrence. 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). Result: 40 patients of complex fistula-in-ano were taken up for study with the age (mean±standard deviation) of 35±10.6 years. The Roederâ??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 Roederâ??s knot with Rajneeshâ??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 Roederâ??s knot tightened in OPD after application of 2% xylocaine jelly. Incontinence was assessed according to Wexner score.

Biography :

Rajneesh Kumar, is an Associate Professor in Department of Surgery at Punjab Institute of Medical sciences, Jalandhar, Punjab, India. His main focus is to develop and apply innovations according to the need of poor rural patients in the field of general, trauma and laparoscopic surgery. He has been awarded various honorary fellowships. After serving for 20 years in state health services as laparoscopic, general and gynae surgeon, his activities now involve teaching undergraduate and postgraduate students and academic research in addition to surgical work. He has many publications to his credit.

E-mail: drrajneeshkumar@ymail.com