The Seton in Anal Fistula Management

Abstract

Fistula-in-ano is a challenging problem where treatment attempts have been traced back to the days of Hippocrates and even earlier. Surgical treatment of fistula-in-ano is dictated by the amount of sphincter involved and internal and external anal sphincters preservation is in the interest of continence maintenance. There are a variety of reasons to use setons in the management of anal fistulas. They consent to drain the track preparatory to an attempted repair (bridge to sphincter preserving techniques), as a way of staging fistulotomy, or to set the stage for spontaneous healing. Although many advocate that loose seton placement should be the gold standard in the management of complex fistula, existing literature results often consist of small/medium volume case series with limited follow-up and conflicting results when compared to other techniques, still leaving to the surgeon the choice of the best treatment based on personal experience and patients’ characteristics.

However, despite the heterogeneity of the studies on this topic, the variability of the results and their methodology usually retrospective and with short follow-up remains the impression that although the seton is an ancient treatment, its role in fistula management is still predominant and can be further explored.