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