Management of High Anal Fistula With Cutting Seton

Ainul Hadi, Shehla Faridoon

Abstract

Objective

To evaluate the utility of cutting seton in the treatment of high fistula-in-ano.

Study design

Descriptive case series.

Place & Duration of study

Surgical B Unit, Hayatabad Medical Complex, Peshawar, from November 2021 to October 2022.

Methodology

Patients with the diagnosis of high anal fistulae were included. In all patients proctoscopy was done. Fistulogram was performed in all patients while MRI was requested in selected cases. Patients with Crohn’s disease, tuberculosis, HIV infection, malignancy and complex fistulae with multiple external openings, were excluded. Informed consent was taken after approval of the study from institution review board.

Bowel preparation was started a day before surgery. Procedure was performed under general or spinal anesthesia. Polypropylene size 1 (Prolene® Ethicon) was used as a cutting seton. Patients were discharged on the following day after surgery. Oral antibiotics and laxative were prescribed. Special instructions were given on personal hygiene. Patients were advised to visit after two weeks for tightening of seton. Follow up continued for six months. Data were recorded and analysed on SPSS 22. Descriptive statistics were used to present data in numbers and percentages. 

Results

A total of 42 patients were included. There were 35 (83.3%) males and 07 (11.7%) females patients with M:F of 5:1. Age of the patients was from 23 years to 68 years with the mean age of 39±6.5 years. There were 31 (73.8%) were primary and 11 (26.2%) recurrent fistulae. Different types of fistula included transsphincteric (n=25 -59.5%), intersphincteric (n=12 - 28.6%) and suprasphincteric (n=5 - 12.0%). In 25 (59.5%) patients the internal opening was located at dentate line while in 17 (40.5%) it was above that level. The external opening was located posteriorly in 35 (83.3%) patients. Seton cutting fistulotomy completed within 4-8 weeks and wound healing occurred within 10 weeks. Post procedure minor incontinence to flatus was reported in 05 (12.0%) and recurrence of fistula in 02 (4.7%) patients. The overall success rate was 95.2% (n=40).

Conclusion

Cutting seton is an effective and safe technique for high anal fistula with acceptable low rates of minor flatus incontinence and recurrence rate.

Key words

High fistula-in-ano, Cutting seton, Recurrent fistula-in-ano, Fecal incontinence