Outcomes of Transanal Advancement Flap Repair and Hybrid Seton Placement in 84 Patients With Transsphincteric Anal Fistula

BACKGROUND Transsphincteric fistulas are common pathologies that present a challenge for both surgeons and patients. This study compared 2 reliable methods - transanal advancement flap repair (TAFR) and hybrid seton placement (HSP) - in treatment of transsphincteric fistulas and determined the most appropriate options. MATERIAL AND METHODS In this retrospective study, 84 patients who underwent surgery for transsphincteric anal fistulas between July 2022 and December 2024 were evaluated. Patient archive data, preoperative medical history, and physical examination findings were reviewed. Postoperative symptoms and recovery were assessed using the Cleveland Clinic Incontinence Scoring (CCIS) and Fecal Incontinence Quality of Life (FIQL) scores to evaluate incontinence status and changes in daily life. RESULTS We included 84 patients: 21 females and 63 males, with a mean age of 45.1 years (range: 21-69). TAFR was performed on 36 patients, while 48 patients underwent HSP. Postoperative recurrence was observed in 7 patients. FIQL scores significantly improved postoperatively in both surgical groups, whereas no significant change was observed in CCIS scores. Notably, the TAFR group demonstrated greater improvement in FIQL scores compared to the HSP group (P=0.001). Additionally, anal soiling was significantly more frequent in the hybrid seton group compared to the advancement flap group (P=0.03). CONCLUSIONS Both hybrid seton and transanal advancement flaps are reliable surgical methods that yield good outcomes in treating transsphincteric anal fistulas. However, our results suggest that anal soiling occurs less frequently and quality of life improves more in patients treated with transanal advancement flaps, as reflected by higher postoperative FIQL scores.