RESUMO
Background: Fistula-in-ano is a commonly encountered surgical problem. There is a risk of sphincter muscle damage during fistulectomy. Seton suture is used to decrease this risk. Different types of Setons are used for this purpose
Aim: To compare 2 types of cutting Seton as regard Postoperative pain, duration until Seton cut through, post operative faecal incontinence and recurrence
Methods: This study was conducted on 80 patients in 2 groups with high perianal fistula or low perianal fistula associate with abscess cavity. Patients with inflammatory bowel disease, history of malignancy, and previous recto-anal operations were excluded from this study. One group with insertion of sterilized rubber band and silk suture was applied at the anal verge the other with Ethilon sutures. Follow up and tightening of the seton done as outpatient
Results: About half [46.25%] had low perianal fistulas with abscess cavity, and 53.75% had high perianal fistulas. Group [A] patients had 10% wound infection and group [B] had 5%, all responded to conservative management. The mean VAS score of the patients on the 1st day was [3.7 +/- 1.14], and [2.85 +/- 0.92] and on the 7th day was [1.28 +/- 0.85] and [0.88 +/- 0.88] respectively. Seton fell down after a mean time [26.35 days +/- 5.12 days] in group [A] and [27.65 days +/- 6.84 days] in group [B]. Complete healing was achieved in 77.5% of group [A] and in 60 % of group [B] after 1 month and 40 patients [100%] in both groups at 3 months. 7.5% of recurrence in group [A] and 2.5% case of recurrence in group [B]
Conclusion: Rubber band Seton is easy and cheap and provide slow and steady cutting of the sphincter maintaining continence