Tight Cutting Seton for Anal Fistulae Revisited

Abstract

Abstract Background: Anal fistulas are a common medical problem affecting thousands of patients annually well over 2000 years. There are many new novel approaches to this old condition but none with overwhelming success and low complication rates. The aim of this retrospective review was to revisit our experience in the treatment of anal fistulas with a tight cutting seton. Objectives: Observational study of retrospective collected data. Design: Retrospective study. Patients and Methods: Between 2008 - 2018 a retrospective study included all patients with primary or recurrent fistulas who were treated using tight seton were analyzed. Main Outcome Measures: The primary outcomes measured were healing rate, procedure-related complications, and incontinence. Sample Size: The study included 41 cases of anal fistula treated with a tight cutting and complete records of follow-up. Results: Firty-one patients with a median age of 37.9 years with a median follow up of 14.37 months were identified and included in the study. Among these, 66% of the fistulas were primary and 34% persisting or recurrent fistulas. Fistulas were classified as trans-sphincteric in 71% of patients, inter-sphincteric in 20%, horseshoe in 7%, and extra-sphincteric in 2% of the patients. All patients were treated with a cutting seton. The total healing rate was 95%. Two patients developed a persistent fistula. Four patients (9.8%) complained of different degrees of incontinence. There were no incidents of solid stool incontinence. In one case, the cause of fecal incontinence was keyhole deformity which was resolved after a buried island transposition flap. Conclusion: Our study evaluates a series of patients who were treated by a single surgeon in nonrandomized studies, emphasizing that tight cutting seton technique first described by Hippocrates in 430 BCE is a simple, highly effective, and safe procedure that should not be abandoned. Limitations: This study has limitations, including its retrospective nature. We collected data for this study from electronic records and databases of patients after completion of followup. Conflict of Interest Statement: The authors declare that there is no conflict of interests in this study.