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Subject Area

Anesthesiology and Intensive Care

Article Type

Original Study

Abstract

Objective The aim of this study was to evaluate the effectiveness, frequency of incontinence, and recurrence after treatment of complex perianal fistula with cutting seton. Background Cutting seton commonly is prescribed for complex perianal fistula, because it is simple and cheap, but high incontinence rates suggest that cutting seton can damage continence musculature. Patients and methods A study was carried out in Damanhur Medical National Institute Colorectal Unit from October 2013 to October 2016 and included 30 patients with complex anal fistula. Patients were treated with cutting silk seton. Patients were followed-up for tightening or change of seton and for observing complications like incontinence and recurrence. Results There were 24 male and six female. Mean age was 38 years. There were 14 high intersphincteric, 12 trans-sphincteric, and four suprasphincteric fistulas. Time taken for seton to cut through the fistulous tract varied from 4 to 10 weeks. Fistulas completely healed in 90% of the patients in 12 weeks. Recurrence of fistula developed in 10% of patients during the follow-up period. A total of six patients experienced minor incontinence, with two from each type of fistula in the study. Incontinence was to flatus in two patients and to liquid stool in four patients. There were no incidents of solid stool incontinence. Conclusion Use of cutting seton in treatment of complex perianal fistula is simple and cheap. This commonly used technique can damage continence musculature. Other techniques that do not cut the sphincter, when available, should be performed for higher fistula and anterior fistula in female.

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