Non-cutting setons for progressive migration of complex fistula tracts: a new spin on an old technique
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We introduced a modification of the loose seton for high transsphincteric fistula which involved daily self-rotation of the seton by 360°, which we call the progressive migration technique. The outcomes were evaluated.
A retrospective review was undertaken of all operations for anal fistula performed by a single colorectal surgeon from Jan. 2002–Dec. 2007. Twenty-four patients with high transsphincteric fistulas were treated with loose, 0-silk setons. Patients were asked to rotate the seton daily, one revolution in each direction, pulling the knot through the fistula tract. Follow-up was done by phone with questionnaires to address incontinence pain scores, satisfaction, and recurrence.
The patients' mean age was 48 years (range, 22–77 years), with M/F ratio of 3:1. The mean duration for seton in place was 14 months (range, 2–40 months). Follow-up ranged from 12–81 months (mean, 45 months). The progressive migration technique resulted in the gradual healing of the fistula tract in 75% of patients (n = 18), with no recurrence (setons completely worked their way to the surface [n = 9], or tract migration was extensive to allow a safe completion fistulotomy [n = 9]). All were fistula free. Twenty-five percent (n = 6) had Crohn's disease. Reported incontinence rates were 0% for solid and liquid stool and 8% (n = 2) for flatus. Twenty-five percent (n = 6) tolerated the setons poorly, and an alternative procedure was performed.
Simple daily self-rotation of a heavy silk seton, resulting in progressive migration of the fistula tract, is an alternative technique for treating complex, high transsphincteric anal fistulas.
KeywordsAnal fistula Loose seton Incontinence Recurrence Fistulotomy
The authors thank Jeffrey C. Flynn, PhD, for his help in the review of this manuscript.
Conflict of interest
Institutional review board approval was obtained before the start of study. There are no personal conflicts of interest of any authors. There have been no sources of outside support or funding.