Preliminary Seton Before Fistulectomy: A Single Institute Experience in Treating Fistula in Ano; 1 Year Follow up Results

Abstract

Aim: To analyze the results of treating fistula-in-ano using a preliminary Seton followed by fistulectomy and sphincter repair 2-4 months later. Method:This is a retrospective study of 56 patients with transsphincteric and complex anal fistulas, managed preliminary with loose Seton followed by fistulectomy and sphincter repair 2-4 months later between March 2011 and March 2013. Patients were seen at the clinic 1 week, 3 months and 1 year after the surgery. Patients were observed for complications and recurrence and incontinence was noted according to Cleveland Clinic score. Result:Twenty-five (45%) of the fistulas were high or complex. Twenty-nine (51.7%) of the patients had a history of previous surgery.Forty-nine (88%) of the cases were done as a day case surgeries.The Seton was kept in situ for 2-5 months (average 2.6 months). Complete healing was achieved within 3.7 weeks on average (2-8 weeks). The mean follow up was 20.5 months (12-36 months). Two patients had temporary flatus incontinence which had both resolved over a period of 2-3 months. Recurrence happened in two (3.6 %) patients and 54 (94.4%) of the patients had complete cure. Conclusion: Preliminary Seton followed by fistulectomy and sphincteroplasty has shown to be highly effective in treating transsphincteric and complex fistulas with low recurrence rates (2/56=3.6%) and no risk of subsequent incontinence.