The Clinical Effect of Sphincter-Preserving Modified Loose Seton Technique in Complex Anal Fistula

ABSTRACT

PURPOSE: The cutting seton technique is a world-wide operative method in management of a complex anal fistula. However it has still some risks of anal deformity and fecal incontinence because of sphincter injury, and also required two-stage operation under the anesthesia. We have modified this conventional method into sphincter-preserving technique using the seton and evaluated the clinical effect of patients with complex anal fistula. METHODS: The operative steps consisted of excision of the fistular tract without cutting the sphincter, and insertion of a non-absorbable suture material as a seton around the sphincter. When enough fibro-granulated tissues grew and pus discharge decreased markedly, the seton was just cut out from the wound without anesthesia at the outpatient basis. The clinical effect following treatment by using this method was assessed retrospectively in 81 patients, including 33 recurrent cases, who were treated during the four and a half-year period. RESULTS: The average follow-up period to remove the seton and to eradicate the fistula was 68.9+/-39.5 and 82.1+/-45.6 days, respectively. No patients experienced fecal incontinence after surgery. The fistula was healed without recurrence in 78 patients (96.3%), preserving integrity of the sphincter. Recurrence developed in 3 patients who had two suprasphincteric fistulas and one transsphincteric fistula with supralevator abscess. CONCLUSION: We suggest that this method is good for treating complex anal fistulas without two-stage operation because it has some advantages such as a lower recurrence, a lower functional impairment, and less anal deformity.