Definitive seton management for transsphincteric fistula-in-ano: harm or charm?

Area of Science:

• Colorectal Surgery
• Surgical Innovation
• Fistula Treatment

Background:

• Transsphincteric anal fistula treatment necessitates balancing disease eradication with maintaining fecal continence.
• The cutting seton, an older surgical tool, is less frequently used but may offer reliable outcomes.

Purpose of the Study:

• To evaluate the safety and efficacy of the cutting seton technique for transsphincteric anal fistula.
• To compare the outcomes of cutting seton treatment with those of recently developed fistula treatment methods.

Main Methods:

• Retrospective review of 121 patients treated with a cutting seton between 2001 and 2014.
• Exclusion criteria included Crohn's disease, malignancy-related fistulas, previous anastomosis, and alternative treatments.
• Data collected included demographics, disease duration, treatment duration, outcomes, and continence status.

Main Results:

• The median healing time was 3 months, with 98% of patients achieving complete fistula healing.
• Postoperative incontinence decreased to 11.6% from a baseline of 19%, with resolution in many patients.
• Only 7.4% of patients required additional surgery, indicating a high success rate.

Conclusions:

• The cutting seton is a safe, well-tolerated, and highly successful treatment for transsphincteric anal fistula.
• This technique leads to improved fecal continence post-treatment.
• Outcomes achieved with the cutting seton compare favorably to other fistula treatment modalities.