cutting seton technique for management of high perianal fistula

ABSTRACT

Seton technique have been used for treatment of high perianal fistula for thousands of years with successful results. This prospective study reports the results of the cutting seton technique in addition to distal fistulotomy for treatment of high perianal fistula. Twenty two patients, 17 [77.3%] males and 5 [22.7%] females, aged between 20 and 57 years [median 35.5 years] presented with high perianal fistula included in this study. While the patients in the lithotomy position, injection of methylene blue followed by probing was done, care was taken not to do false passage. Subcutaneous track was bayed open till anal sphincter complex, the anoderm and the mucosa overlying the fistula was incised, 2 Nylon No 1 sutures were passed through the fistula and tied over the sphincter complex. The ties were tightened every two weeks in outpatient clinic postoperatively. Thirteen [65%] patients had a normal postoperative continence but 7 patients [35%] had postoperative incontinence [4 patients [20%] incontinent for gases, 2 patients [10%] incontinent for liquid stool and one patient [5%] incontinent for solid stool]. Six patients had been completely recovered and one had permanent incontinence. All fistulae were healed from 10 to 20 weeks [median 14 weeks]. There were two fistulae recurrence during the study period, one was treated successfully by the same procedure