Cutting seton for complex anal fistulas

Abstract

A standardised protocol for performing a cutting seton has not been well described in the existing literature. The aim of this study was to examine our experience of treatment of complex anal fistulas by cutting seton over 15 years in our hospital, detailing surgical technique, results and complications. Between 1990 and 2004, 112 patients with complex anal fistulas were treated by applying cutting setons in our hospital. The elastic band from a surgical glove was used as the seton material. The seton was re-tightened for the first time in the second week after the initial operation and then at weekly intervals. There were 98 male and 14 female patients, with a median age of 43 years. Eighty-four patients had trans-sphincteric or suprasphincteric fistulas, and 28 patients had extrasphincteric fistulas. The mean operative time was 42 minutes. The mean number of seton ties was 3-3 times. The mean duration with the seton in place was 28.7 days. The mean time of the wound healing was 9.3 weeks. Median period of follow-up was 38.6 months. Recurrence was found in one patient (0.9%). Twenty-seven patients (24.1%) were noted with continence disorders, including gas incontinence in 21 patients (18.6%) and liquid stool incontinence in 6 patients (5.4%). There were no incidents of solid stool incontinence. Using the elastic band from a surgical glove as a seton with repeated tightening at weekly intervals is safe and effective, with shorter duration of wound recovery, low recurrence and less continence disorders.