High peri-anal fistula, is there a place for seton in their management?

ABSTRACT

Thirty patients with high perianal fistulae were selected [22 males and 8 females with an average age ranging from 13 to 65 years] for this study. The main presenting symptoms were discharge [100%], pruritis ani [60%], pain [23.3%], swelling [16.6%], diarrhea [6.6%], constipation [6.6%] and fever [3.3%]. Fistulogram was accurate to demarcate the fistulous tract in 23 patients [76.6%] and most of the patients were managed under spinal or caudal block anesthesia. Fifteen patients were treated by fistulectomy operation [group I] and the other 15 patients were treated by cutting seton [group II]. In spite of the slight increase in pain amplitude and the increased discharge in seton group, the period of hospital stay was less [three days with seton versus seven days for fistulectomy] and the mean time needed for healing was also reduced [1.5 months for seton versus 3 months for fistulectomy]. Moreover, recurrence was encountered in only two cases after seton versus three cases after fistulectomy. However, the incidence of mild loss of sphincteric control was more after seton group [eight cases versus six cases after fistulectomy]. Most of them were slightly incontinence to flatus