Research Article Volume 8 • Issue 1 139 Eﬃcacy and Patient Outcomes of Hybrid Rubber Seton in the Management of Complex Anal Fistulas Tariq Akhtar Khan 1* , Mohammad Ali 2 , Krishna Pada Saha 3 , Md. Nashir Uddin 4 , Md. Lutful Kabir Khan 5 , Nunjirul Muhsenin 6 , Nazmun Nahar 7 , Sawantee Joarder 8 , Md. Kuddus Ali Khan 9 Aﬃliation: 1 Department of Colorectal Surgery, Mugda Medical College and Hospital, Dhaka, Bangladesh 2 Department of Colorectal Surgery, Shaheed Suhrawardy Medical College and Hospital, Dhaka, Bangladesh 3 Department of Colorectal Surgery, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh 4 Department of Surgery, Mugda Medical College and Hospital, Dhaka, Bangladesh 5 Department of Anesthesiology & Pain Medicine, Super Specialized Hospital & Impulse Hospital, Dhaka, Bangladesh 6 Department of Surgery, Dhaka Dental College and Hospital, Dhaka, Bangladesh 7 Department of Surgery, MARKS Medical College and Hospital, Dhaka, Bagnladesh 8 Department of Urology, Evercare Hospital, Dhaka, Bangladesh 9 Department of Surgery, Mugda Medical College and Hospital, Dhaka, Bangladesh *Corresponding author: Tariq Akhtar Khan, Associate Professor, Department of Colorectal Surgery, Mugda Medical College and Hospital, Dhaka, Bangladesh. Citation: Tariq Akhtar Khan, Mohammad Ali, Krishna Pada Saha, Md. Nashir Uddin, Md. Lutful Kabir Khan, Nunjirul Muhsenin, Nazmun Nahar, Sawantee Joarder, Md. Kuddus Ali Khan. Eﬃcacy and Patient Outcomes of Hybrid Rubber Seton in the Management of Complex Anal Fistulas. Journal of Surgery and Research. 8 (2025): 139-144. Received: February 10, 2025 Accepted: February 17, 2025 Published: February 27, 2025 Abstract Background: Complex anal ﬁstulas present a signiﬁcant surgical challenge due to high recurrence rates and the risk of fecal incontinence. The hybrid rubber seton technique, combining features of both cutting and drainage setons, has emerged as a promising approach to improve healing while preserving sphincter function. This study evaluates the eﬃcacy and patient outcomes of hybrid rubber seton placement in the management of complex anal ﬁstulas. Methods: This prospective observational study was conducted from July 2021 to June 2024 across six hospitals in Bangladesh, including 94 patients with complex anal ﬁstulas. Operative details were documented using the St Mark’s Hospital ﬁstula operation note format. Post-operative outcomes, including seton drop time, wound healing duration, recurrence rates, and complications, were recorded. Statistical analysis was performed using SPSS version 25. Results: The majority of patients (78.7%) had high trans-sphincteric ﬁstulas. The median seton drop time was 6 weeks, and 59.6% of patients required more than 60 days for complete wound healing. The recurrence rate within six months was 12.8%, and no cases of permanent fecal incontinence were reported. Reactionary hemorrhage occurred in 27.7% of patients, but no infective complications were observed. Overall, 74.5% of patients reported being very satisﬁed with the procedure. Conclusion: The hybrid rubber seton is an eﬀective and safe technique for managing complex anal ﬁstulas, oﬀering favorable healing rates with minimal risk of incontinence. It remains a viable treatment option, balancing ﬁstula closure and sphincter preservation. Further research should focus on long-term functional outcomes and comparative studies with newer techniques. Keywords: Anal ﬁstula; Hybrid rubber seton; Complex ﬁstula; Seton technique; Fistula healing Introduction Complex anal ﬁstulas pose signiﬁcant challenges in colorectal surgery due to their high recurrence rates and the risk of fecal incontinence following treatment [1,2]. These ﬁstulas often involve multiple or high tracts crossing diﬀerent sphincteric planes, necessitating a delicate balance between sepsis eradication and sphincter preservation [3]. Various surgical techniques have been developed, including advancement ﬂaps, ligation of the intersphincteric ﬁstula tract (LIFT), ﬁstula plug and seton placement. Among these, the use