Advertisement

Diseases of the Colon & Rectum

, Volume 36, Issue 6, pp 573–579 | Cite as

Role of the seton in the management of anorectal fistulas

  • Russell K. Pearl
  • John R. Andrews
  • Charles P. Orsay
  • Robert I. Weisman
  • M. Leela Prasad
  • Richard L. Nelson
  • Jose R. Cintron
  • Herand Abcarian
  • David A. Rothenberger
  • Russell K. Pearl
Original Contributions

Abstract

PURPOSE: To identify the incidence of major fecal incontinence and recurrence after staged fistulotomy using a seton. METHODS: A five-year retrospective chart review of 116 patients (70 males and 46 females) ranging in age from 18 to 81 years (mean, 42 years), in whom setons were placed as part of a surgical procedure for anorectal fistulas, was carried out. Follow-up ranged from 2 to 61 months (mean, 23 months). RESULTS: Setons were employed to identify and promote fibrosis around a complex anorectal fistula as part of a staged fistulotomy in 65 patients (56 percent). Other indications for seton placement included 24 women with anteriorly situated high transsphincteric fistulas (21 percent) and three patients with massive anorectal sepsis (floating, freestanding anus) (2.5 percent). In addition, setons were used to preclude premature skin closure and promote controlled long-term fistula drainage in 21 patients with severe anorectal Crohn's disease (18 percent) and in three patients with AIDS (2.5 percent). Major fecal incontinence (requiring the use of a perineal pad) occurred in five patients (5 percent), and recurrent fistulas were noted in three (3 percent). CONCLUSIONS: Staged fistulotomy using a seton is a safe and effective method of treating high or complicated anorectal fistulas.

Key words

Seton Fistula Fistulotomy 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Ramanujam P, Prasad ML, Abcarian H. The role of seton in fistulotomy of the anus. Surg Gynecol Obstet 1984;157:419–22.Google Scholar
  2. 2.
    Kuypers HC. Use of the seton in the treatment of extrasphincteric anal fistula. Dis Colon Rectum 1984;27:109–10.PubMedGoogle Scholar
  3. 3.
    Culp CE. Use of Penrose drains to treat certain anal fistulas: a primary operative seton. Mayo Clin Proc 1984;59:613–7.PubMedGoogle Scholar
  4. 4.
    Christensen A, Nilas J, Christiansen J. Treatment of transsphincteric anal fistulas by the seton technique. Dis Colon Rectum 1986;29:454–5.PubMedGoogle Scholar
  5. 5.
    Held D, Khubchandani I, Sheets J, Stasik J, Rosen L, Riether R. Management of anorectal horseshoe abscess and fistula. Dis Colon Rectum 1986;29:793–7.PubMedGoogle Scholar
  6. 6.
    Fasth SB, Nordgren S, Hulten L. Clinical course and management of suprasphincteric and extrasphincteric fistula-in-ano. Acta Chir Scand 1990;156:397–402.PubMedGoogle Scholar
  7. 7.
    Williams JG, MacLeod CA, Rothenberger DA, Goldberg SM. Seton treatment of high anal fistulae. Br J Surg 1991;78:1159–61.PubMedGoogle Scholar
  8. 8.
    Ustynoski K, Rosen L, Stasik J, Rietner R, Sheets J, Khubchandani IT. Horseshoe abscess fistula: seton treatment. Dis Colon Rectum 1990;33:602–5.PubMedGoogle Scholar
  9. 9.
    Kennedy HL, Zegarra JP. Fistulotomy without external sphincter division for high anal fistulae. Br J Surg 1990;77:898–901.PubMedGoogle Scholar
  10. 10.
    Mason AY. Trans-sphincteric exposure for low rectal anastomosis. J R Soc Med 1972;65:974.Google Scholar
  11. 11.
    Kraske P. Zur exstirpation hochsitzender mastdramkrebse. Verh Dtsch Ges Chir 1885;14(Part 2):464.Google Scholar

References

  1. 1a.
    Williams JG, MacLeod CA, Rothenberger DA, Goldberg SM. Seton treatment of high anal fistulae. Br J Surg 1991;78:1159–61.PubMedGoogle Scholar
  2. 2a.
    Mann CV, Clifton MA. Rerouting the track for the treatment of high anal and anorectal fistulae. Br J Surg 1985;72:134–7.PubMedGoogle Scholar
  3. 3a.
    Reznick RK, Bailey HR. Closure of the internal opening for treatment of complex fistula-in-ano. Dis Colon Rectum 1988;31:116–8.PubMedGoogle Scholar
  4. 4a.
    Aguilar PS, Plasemcia G, Hardy TG,et al. Mucosal advancement in the treatment of anal fistula. Dis Colon Rectum 1985;28:496–8.PubMedGoogle Scholar
  5. 5a.
    Wedel J, Meir. Sliding flap advancement for the treatment of high level fistulae. Br J Surg 1987;74:390–1.PubMedGoogle Scholar
  6. 6a.
    Jones IT, Fazio VW, Jagelman DC. The use of transanal rectal advancement flaps in the management of fistulas involving the anorectum. Dis Colon Rectum 1987;30:919–23.PubMedGoogle Scholar
  7. 7a.
    Shemesh BI, Kodner IF, Fry RD, Neufeld DM. Endorectal sliding flap repair of complicated anterior anoperineal fistulas. Dis Colon Rectum 1988;31:22–4.PubMedGoogle Scholar
  8. 8a.
    Parks AG, Stitz RW. The treatment of high fistula-inano. Dis Colon Rectum 1976;19:487–99.PubMedGoogle Scholar
  9. 9a.
    Christensen A, Nilas J, Christiansen J. Treatment of transsphincteric anal fistulas by the seton technique. Dis Colon Rectum 1986;29:454–5.PubMedGoogle Scholar
  10. 10a.
    Relman A. Assessment and accountability: the third revolution in health care. N Engl J Med 1988;319:1221–2.Google Scholar
  11. 11a.
    Ellwood PM. Outcomes management: a technology of patient experience. N Engl J Med 1988;318:1549–56.PubMedCrossRefGoogle Scholar

Copyright information

© American Society of Colon and Rectal Surgeons 1993

Authors and Affiliations

  • Russell K. Pearl
    • 1
    • 2
  • John R. Andrews
    • 1
    • 2
  • Charles P. Orsay
    • 1
    • 2
  • Robert I. Weisman
    • 1
    • 2
  • M. Leela Prasad
    • 1
    • 2
  • Richard L. Nelson
    • 1
    • 2
  • Jose R. Cintron
    • 1
    • 2
  • Herand Abcarian
    • 1
    • 2
  • David A. Rothenberger
    • 3
  • Russell K. Pearl
    • 4
  1. 1.The Section of Colon and Rectal SurgeryCook County HospitalChicago
  2. 2.The Department of SurgeryUniversity of Illinois College of Medicine at ChicagoChicago
  3. 3.St. Paul
  4. 4.Chicago

Personalised recommendations