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Functional results after seton treatment of high transsphincteric anal fistulas
W Graf1, L Påhlman, S Ejerblad
1Department of Surgery, Akademiska sjukhuset, Uppsala, Sweden.
Objective:
To evaluate the functional outcome after seton treatment of high transsphincteric anal fistulas.
Design:
Retrospective study.
Setting:
University hospital, Sweden.
Subjects:
29 patients (8 women, mean age 46, range 25-71) with high transsphincteric anal fistulas 1983-1992.
Interventions:
Setons were inserted in the anal fistulas in all patients.
Main Outcome Measures:
Anal continence evaluated by a questionnaire a mean of 46 months postoperatively. Clinical data were collected from the patients' records.
Results:
All four patients with inflammatory bowel disease had some incontinence. Of the remaining 25 patients, 11 (44%) complained of incontinence and 2 (8%) developed recurrent fistulas. Incontinence was more common when the seton was tightened at the last procedure (7/9) compared with those in which the tissue enclosed by the seton was divided (4/16, p = 0.03). No other preoperative or operative characteristic significantly influenced the risk of incontinence.
Conclusion:
Incontinence is common after seton treatment of high transsphincteric anal fistulas. The risk seems to be higher when the muscle remains viable after a period of seton treatment.