Comparison of Postoperative Pain and Functionality in Patients Undergoing Fistulotomy and Seton for Anal Fistula

Abstract

Abstract Introduction: Anal fistula is a common proctological disease characterized by a tunnel formation between the skin and the anal canal. Surgical intervention is often required for treatment. The study aimed to assess postoperative pain and functionality in patients undergoing either fistulotomy or seton application for anal fistula. Method: The study included patients undergoing fistulotomy or seton application. Pain and functionality were assessed using the WHODAS 2.0 and VAS scores before surgery and at 1 week and 1 month post-surgery. Data were analyzed using statistical methods. Results: Out of 144 patients, 125 were included in the study. Fistulotomy was performed in 54.4% of patients, while seton application was performed in 45.6%. Pain levels were significantly higher in the fistulotomy group at postoperative 1 week but significantly lower at postoperative 1 month compared to the seton group. WHODAS 2.0 results correlated with VAS scores, showing that pain affected functionality. Seton group patients experienced less pain in the first postoperative week, but pain increased in the first month due to the presence of setons. Loss of function in social life and human relations was higher in the seton group. Discussion: Anal fistulas are more prevalent in men, but this study found a higher ratio of women, possibly due to geographical differences or the small sample size. Pain levels and functionality were affected by the choice of surgical method. Fistulotomy patients experienced increased pain in the first week but improved over time, while seton patients had lower initial pain but more persistent discomfort. Setons can disrupt daily life and social activities. Surgeons should consider long-term pain and functionality when choosing between procedures.